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Several calcium-channel blockers have been associated with worsening heart failure or increased mortality in patients with left ventricular dysfunction. In this randomized trial, 1153 patients with severe chronic heart failure (NYHA class IIIB or IV, and ejection fraction below 30 percent while on standard drug therapy) received either amlodipine (5 or 10 mg daily) or placebo.
The principal endpoint was all-cause mortality plus nonfatal cardiac morbidity (i.e., pulmonary edema, hypoperfusion, myocardial infarction, and sustained ventricular arrhythmia). In patients with ischemic cardiomyopathy (63 percent of the total), outcomes were similar in the amlodipine and placebo groups during a median follow-up of 14 months. However, in those with n…