title: Effects of prescribed antihypertensives and other cardiovascular drugs on mortality in patients with atrial fibrillation and hypertension: a cohort study from Sweden.
abstract: Although antihypertensive drugs are known to reduce mortality in individuals with hypertension, the effects of different cardiovascular pharmacotherapies on mortality among patients with hypertension and atrial fibrillation (AF) have been less thoroughly explored. To study mortality rates in men and women separately with hypertension and AF prescribed different cardiovascular pharmacotherapies. A cohort of men (n=2809) and women (n=2793) aged >45 years diagnosed with hypertension and AF were selected using patient records. Hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated using Cox regression, with all-cause mortality as the outcome. Analysis was performed on the whole population and after stratification by age and sex. Independent factors were prescribed pharmacotherapies. Adjustments were made for a propensity score comprising age, comorbidities, education and marital status. The higher the number of antihypertensive drugs prescribed, the lower the mortality rate (P-value for trend 0.005). Individuals prescribed 4-5 antihypertensive drugs had a lower risk of mortality than those prescribed 0-1 drugs (HR: 0.62; 95% CI: 0.45-0.86). The HRs for the following drug classes were: loop diuretics 1.39 (95% CI: 1.08-1.78), non-selective β-blockers 0.68 (95% CI: 0.53-0.88), angiotensin receptor blockers 0.75 (95% CI: 0.56-0.99) and statins 0.68 (95% CI: 0.53-0.88). AF patients with hypertension prescribed statins, non-selective β-blockers and angiotensin receptor blockers had low relative mortality risks, suggesting that these prescribed pharmacotherapies were beneficial. This needs to be further explored in other clinical settings.
authors.affiliation: 1] Centre for Family Medicine, Karolinska Institutet, Huddinge, Stockholm, Sweden [2] Department of Medical Sciences, Molecular Epidemiology and Science for Life Laboratory, Uppsala University, Uppsala Sweden.
authors.forename: Axel C
authors.initials: AC
authors.lastname: Carlsson
authors.affiliation: Centre for Family Medicine, Karolinska Institutet, Huddinge, Stockholm, Sweden.
authors.forename: Per
authors.initials: P
authors.lastname: Wändell
authors.affiliation: 1] Center for Primary Health Care Research, Lund University/Region Skåne, Malmö, Sweden [2] Stanford Prevention Research Center, Stanford University School of Medicine, Palo Alto, CA, USA.
authors.forename: Kristina
authors.initials: K
authors.lastname: Sundquist
authors.affiliation: Center for Primary Health Care Research, Lund University/Region Skåne, Malmö, Sweden.
authors.forename: Sven-Erik
authors.initials: SE
authors.lastname: Johansson
authors.affiliation: 1] Center for Primary Health Care Research, Lund University/Region Skåne, Malmö, Sweden [2] Stanford Prevention Research Center, Stanford University School of Medicine, Palo Alto, CA, USA.
authors.forename: Jan
authors.initials: J
authors.lastname: Sundquist
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D000369:Aged, 80 and over; D057911:Angiotensin Receptor Antagonists / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000188:drug therapy* / Q000401:mortality*; D002317:Cardiovascular Agents / Q000627:therapeutic use*; D015331:Cohort Studies; D015897:Comorbidity; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D012044:Regression Analysis; D049994:Sodium Potassium Chloride Symporter Inhibitors / Q000627:therapeutic use; D013548:Sweden; D016896:Treatment Outcome
chemical_list: D000319:Adrenergic beta-Antagonists; D057911:Angiotensin Receptor Antagonists; D000959:Antihypertensive Agents; D002317:Cardiovascular Agents; D049994:Sodium Potassium Chloride Symporter Inhibitors