title: Anti-hypertensive medications and cardiovascular events in older adults with multiple chronic conditions.
abstract: OBJECTIVE
  Randomized trials of anti-hypertensive treatment demonstrating reduced risk of cardiovascular events in older adults included participants with less comorbidity than clinical populations. Whether these results generalize to all older adults, most of whom have multiple chronic conditions, is uncertain.
  
  
  OBJECTIVE
  To determine the association between anti-hypertensive medications and CV events and mortality in a nationally representative population of older adults.
  
  
  METHODS
  Competing risk analysis with propensity score adjustment and matching in the Medicare Current Beneficiary Survey cohort over three-year follow-up through 2010.
  
  
  METHODS
  4,961 community-living participants with hypertension.
  
  
  METHODS
  Anti-hypertensive medication intensity, based on standardized daily dose for each anti-hypertensive medication class participants used.
  
  
  METHODS
  Cardiovascular events (myocardial infarction, unstable angina, cardiac revascularization, stroke, and hospitalizations for heart failure) and mortality.
  
  
  RESULTS
  Of 4,961 participants, 14.1% received no anti-hypertensives; 54.6% received moderate, and 31.3% received high, anti-hypertensive intensity. During follow-up, 1,247 participants (25.1%) experienced cardiovascular events; 837 participants (16.9%) died. Of deaths, 430 (51.4%) occurred in participants who experienced cardiovascular events during follow-up. In the propensity score adjusted cohort, after adjusting for propensity score and other covariates, neither moderate (adjusted hazard ratio, 1.08 [95% CI, 0.89-1.32]) nor high (1.16 [0.94-1.43]) anti-hypertensive intensity was associated with experiencing cardiovascular events. The hazard ratio for death among all participants was 0.79 [0.65-0.97] in the moderate, and 0.72 [0.58-0.91] in the high intensity groups compared with those receiving no anti-hypertensives. Among participants who experienced cardiovascular events, the hazard ratio for death was 0.65 [0.48-0.87] and 0.58 [0.42-0.80] in the moderate and high intensity groups, respectively. Results were similar in the propensity score-matched subcohort.
  
  
  CONCLUSIONS
  In this nationally representative cohort of older adults, anti-hypertensive treatment was associated with reduced mortality but not cardiovascular events. Whether RCT results generalize to older adults with multiple chronic conditions remains uncertain.
authors.affiliation: Department of Medicine, Yale School of Medicine, New Haven, Connecticut, United States of America; Yale School of Public Health, New Haven, Connecticut, United States of America.
authors.forename: Mary E
authors.initials: ME
authors.lastname: Tinetti
authors.affiliation: Department of Medicine, Yale School of Medicine, New Haven, Connecticut, United States of America.
authors.forename: Ling
authors.initials: L
authors.lastname: Han
authors.affiliation: Department of Medicine, Yale School of Medicine, New Haven, Connecticut, United States of America.
authors.forename: Gail J
authors.initials: GJ
authors.lastname: McAvay
authors.affiliation: Oregon State University/Oregon Health and Science University, College of Pharmacy, Portland, Oregon, United States of America.
authors.forename: David S H
authors.initials: DS
authors.lastname: Lee
authors.affiliation: Yale School of Public Health, New Haven, Connecticut, United States of America.
authors.forename: Peter
authors.initials: P
authors.lastname: Peduzzi
authors.affiliation: Department of Medicine, Brigham and Women's Hospital/Harvard Medical School, Boston, Massachusetts, United States of America.
authors.forename: John A
authors.initials: JA
authors.lastname: Dodson
authors.affiliation: Department of Medicine, Yale School of Medicine, New Haven, Connecticut, United States of America.
authors.forename: Cary P
authors.initials: CP
authors.lastname: Gross
authors.affiliation: Yale School of Public Health, New Haven, Connecticut, United States of America.
authors.forename: Bingqing
authors.initials: B
authors.lastname: Zhou
authors.affiliation: Yale School of Public Health, New Haven, Connecticut, United States of America.
authors.forename: Haiqun
authors.initials: H
authors.lastname: Lin
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000145:classification / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000188:drug therapy* / Q000401:mortality; D002908:Chronic Disease; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D057216:Propensity Score; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
chemical_list: D000959:Antihypertensive Agents