Assessing the impact of medication use on trends in major coronary risk factors in older British men: a cohort study.
OBJECTIVE
To investigate the role of medication in 20-year trends in blood pressure (BP) and blood lipids in older British men.


RESULTS
BP and lipids were measured in 4231 men from a representative cohort at baseline (1978-1980, aged 40-59 years) and after 20 years (1998-2000). Cohort-wide age-adjusted 20-year mean changes were as follows: systolic BP -7.6 mmHg (95% confidence interval: -9.7 to -5.4); diastolic BP +3.3 mmHg (+2.2 to +4.5); non-high-density lipoprotein (HDL)-cholesterol -0.4 mmol/l (-0.5 to -0.2); HDL-cholesterol +0.16 mmol/l (+0.13 to +0.19). Much (79%) of the systolic BP fall occurred only among 1561 men (37%) reporting the use of BP-lowering medication during the follow-up; systolic BP changed by -12.3 mmHg (-14.7 to -9.9) and -1.6 mmHg (-3.7 to +0.5) among medication users and men not using medication, respectively (P<0.001 for medication-time interaction). One-third of the non-HDL-cholesterol fall occurred only among 302 men (8%) reporting the use of lipid-regulating drugs; non-HDL-cholesterol changed by -1.8 mmol/l (-2.0 to -1.6) and -0.2 mmol/l (-0.4 to -0.1) among medication users and men not using medication, respectively (P<0.001 for interaction). The HDL-cholesterol increase was not associated with lipid-regulating drug use (P=0.15 for interaction).


CONCLUSIONS
Decreases in BP were largely confined to medication users and overall changes in non-HDL-cholesterol were modest, suggesting the need for greater efforts to reduce BP and cholesterol among the general population. HDL-cholesterol increased among all men, likely reflecting cohort-wide improvements in associated health behaviours.
Hardoon
Sarah L
SL
Department of Primary Care and Population Health, Division of Population Health, UCL, London, UK. s.hardoon@ucl.ac.uk
Whincup
Peter H
PH
Wannamethee
S Goya
SG
Lennon
Lucy T
LT
Capewell
Simon
S
Morris
Richard W
RW
D000328:Adult; D000367:Age Factors; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D015415:Biomarkers / Q000097:blood; D001794:Blood Pressure / Q000187:drug effects; D002784:Cholesterol / Q000097:blood; D008076:Cholesterol, HDL / Q000097:blood; D015331:Cohort Studies; D003324:Coronary Artery Disease / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D004363:Drug Utilization; D050171:Dyslipidemias / Q000097:blood / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology; D015438:Health Behavior; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology / Q000503:physiopathology; D000960:Hypolipidemic Agents / Q000627:therapeutic use*; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D006113:United Kingdom / Q000453:epidemiology
D000959:Antihypertensive Agents; D015415:Biomarkers; D008076:Cholesterol, HDL; D000960:Hypolipidemic Agents; D002784:Cholesterol
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