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Long‐Term Survival and Use of Antihypertensive Medications in Older Persons
Author(s) -
Pahor Marco,
Guralnik Jack M.,
Corti MariaChiara,
Foley Daniel J.,
Carbonin Pierugo,
Havlik Richard J.
Publication year - 1995
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/j.1532-5415.1995.tb07393.x
Subject(s) - medicine , nifedipine , diltiazem , digoxin , heart failure , prospective cohort study , cohort study , blood pressure , cohort , confidence interval , relative risk , cardiology , calcium
OBJECTIVE: To determine whether older persons with hypertension who use specific calcium antagonists and ACE inhibitors have a different risk of mortality than those using β‐blockers. DESIGN: A prospective cohort study continuing from 1988 through 1992. SETTING: Three communities of the Established Populations for Epidemiologic Studies of the Elderly. PARTICIPANTS: Hypertensive participants aged s 71 years (n = 906) who had no evidence of congestive heart failure and who were using either /3‐blockers (n = 515), verapamil (n = 77), diltiazem (n = 92), nifedipine (n = 74), or ACE inhibitors (n = 148). Nifedipine was of the short acting variety. MEASUREMENTS: The main outcome measure was all‐cause mortality. Age, gender, smoking, HDL‐cholesterol, blood pressure, intake of digoxin and diuretics, physical disability, self‐perceived health, and comorbid conditions were examined as confounders. RESULTS: During 3538 person‐years of follow‐up, 188 participants died (53 deaths per 1000 person‐years). Compared with j3‐blockers, after adjusting for age, gender, comorbid conditions and other health‐related factors, the relative risks (95% confidence interval) for mortality associated with use of verapamil, diltiazem, nifedipine, and ACE inhibitors were 0.8 (0.4‐1.4), 1.3 (0.8‐2.1), 1.7 (1.1–2.7), and 0.9 (0.6‐1.4), respectively. The results were unchanged after excluding participants with other potential contraindications to /3‐blockers and after stratifying on coronary heart disease and use of diuretics. Higher doses of nifedipine were associated with higher mortality. CONCLUSION: Compared with /3‐blockers, use of short acting nifedipine was associated with decreased survival in older hypertensive persons. However, selective factors influencing the use of specific drugs in higher risk patients could not be completely discounted, and final conclusions will depend on clinical trials.