title: Beta-blockers as single-agent therapy for hypertension and the risk of mortality among patients with chronic obstructive pulmonary disease.
abstract: OBJECTIVE
  To assess the association between the type of antihypertensive medication and all-cause mortality among patients with chronic obstructive pulmonary disease (COPD).
  
  
  METHODS
  The cohort comprised 1966 patients (mean [+/- SD] age, 65.8 +/- 10.7 years) enrolled in general internal medicine clinics at seven Veterans Affairs medical centers between December 1996 and October 1999. Patients had a diagnosis of both COPD and hypertension and were receiving single-agent antihypertensive therapy.
  
  
  RESULTS
  Compared with calcium channel blockers, beta-blockers were associated with a decrease in mortality from any cause after adjusting for propensity for having been prescribed a beta-blocker (hazard ratio = 0.57; 95% confidence interval: 0.33 to 0.89). The association was similar when beta-blockers were compared with all other antihypertensive medications, and the decreased risk of mortality was apparent among patients with pre-existing cardiac disease. Restriction of analyses to long-acting calcium channel blockers or to patients who used beta-agonists did not affect the point estimates. Exposure to the remaining classes of antihypertensive agents was not associated with mortality.
  
  
  CONCLUSIONS
  Beta-blockers may have beneficial effects in patients who have COPD, pre-existing cardiac disease, and hypertension. Beta-blockers may not be contraindicated among patients with COPD.
authors.affiliation: Health Services Research and Development Northwest Center of Excellence, Veterans Affairs Puget Sound Health Care System, Seattle, Washington 98108, USA. dau@u.washington.edu
authors.forename: David H
authors.initials: DH
authors.lastname: Au
authors.forename: Chris L
authors.initials: CL
authors.lastname: Bryson
authors.forename: Vincent S
authors.initials: VS
authors.lastname: Fan
authors.forename: Edmunds M
authors.initials: EM
authors.lastname: Udris
authors.forename: J Randall
authors.initials: JR
authors.lastname: Curtis
authors.forename: Mary B
authors.initials: MB
authors.lastname: McDonell
authors.forename: Stephan D
authors.initials: SD
authors.lastname: Fihn
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000368:Aged; D015897:Comorbidity; D000075202:Contraindications; D005260:Female; D006331:Heart Diseases / Q000453:epidemiology; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000401:mortality*
chemical_list: D000319:Adrenergic beta-Antagonists