Long-term survival and use of antihypertensive medications in older persons.
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 beta-blockers.


METHODS
A prospective cohort study continuing from 1988 through 1992.


METHODS
Three communities of the Established Populations for Epidemiologic Studies of the Elderly.


METHODS
Hypertensive participants aged > or = 71 years (n = 906) who had no evidence of congestive heart failure and who were using either beta-blockers (n = 515), verapamil (n = 77), diltiazem (n = 92), nifedipine (n = 74), or ACE inhibitors (n = 148). Nifedipine was of the short acting variety.


METHODS
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 beta-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 beta-blockers and after stratifying on coronary heart disease and use of diuretics. Higher doses of nifedipine were associated with higher mortality.


CONCLUSIONS
Compared with beta-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.
Pahor
M
M
Department of Internal Medicine and Geriatrics, Catholic University, Rome, Italy.
Guralnik
J M
JM
Corti
M C
MC
Foley
D J
DJ
Carbonin
P
P
Havlik
R J
RJ
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D002121:Calcium Channel Blockers / Q000627:therapeutic use*; D005260:Female; D006333:Heart Failure / Q000401:mortality; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000401:mortality; D008137:Longitudinal Studies; D008297:Male; D017202:Myocardial Ischemia / Q000401:mortality*; D016016:Proportional Hazards Models; D012307:Risk Factors; D012737:Sex Factors; D015996:Survival Rate
D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D002121:Calcium Channel Blockers