title: Allopurinol and Cardiovascular Outcomes in Adults With Hypertension.
abstract: Allopurinol lowers blood pressure in adolescents and has other vasoprotective effects. Whether similar benefits occur in older individuals remains unclear. We hypothesized that allopurinol is associated with improved cardiovascular outcomes in older adults with hypertension. Data from the United Kingdom Clinical Research Practice Datalink were used. Multivariate Cox-proportional hazard models were applied to estimate hazard ratios for stroke and cardiac events (defined as myocardial infarction or acute coronary syndrome) associated with allopurinol use over a 10-year period in adults aged >65 years with hypertension. A propensity-matched design was used to reduce potential for confounding. Allopurinol exposure was a time-dependent variable and was defined as any exposure and then as high (≥300 mg daily) or low-dose exposure. A total of 2032 allopurinol-exposed patients and 2032 matched nonexposed patients were studied. Allopurinol use was associated with a significantly lower risk of both stroke (hazard ratio, 0.50; 95% confidence interval, 0.32-0.80) and cardiac events (hazard ratio, 0.61; 95% confidence interval, 0.43-0.87) than nonexposed control patients. In exposed patients, high-dose treatment with allopurinol (n=1052) was associated with a significantly lower risk of both stroke (hazard ratio, 0.58; 95% confidence interval, 0.36-0.94) and cardiac events (hazard ratio, 0.65; 95% confidence interval, 0.46-0.93) than low-dose treatment (n=980). Allopurinol use is associated with lower rates of stroke and cardiac events in older adults with hypertension, particularly at higher doses. Prospective clinical trials are needed to evaluate whether allopurinol improves cardiovascular outcomes in adults with hypertension.
authors: From the Institute of Cardiovascular and Medical Sciences, School of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom (R.L.M., M.R.W., P.H., S.P., A.F.D., R.M.T., J.D.); and Charité - Universitätsmedizin Berlin, Berlin, Germany (J.S.). rachael.macisaac@glasgow.ac.uk.
authors: Rachael L
authors: RL
authors: MacIsaac
authors: From the Institute of Cardiovascular and Medical Sciences, School of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom (R.L.M., M.R.W., P.H., S.P., A.F.D., R.M.T., J.D.); and Charité - Universitätsmedizin Berlin, Berlin, Germany (J.S.).
authors: Janek
authors: J
authors: Salatzki
authors: From the Institute of Cardiovascular and Medical Sciences, School of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom (R.L.M., M.R.W., P.H., S.P., A.F.D., R.M.T., J.D.); and Charité - Universitätsmedizin Berlin, Berlin, Germany (J.S.).
authors: Peter
authors: P
authors: Higgins
authors: From the Institute of Cardiovascular and Medical Sciences, School of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom (R.L.M., M.R.W., P.H., S.P., A.F.D., R.M.T., J.D.); and Charité - Universitätsmedizin Berlin, Berlin, Germany (J.S.).
authors: Matthew R
authors: MR
authors: Walters
authors: From the Institute of Cardiovascular and Medical Sciences, School of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom (R.L.M., M.R.W., P.H., S.P., A.F.D., R.M.T., J.D.); and Charité - Universitätsmedizin Berlin, Berlin, Germany (J.S.).
authors: Sandosh
authors: S
authors: Padmanabhan
authors: From the Institute of Cardiovascular and Medical Sciences, School of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom (R.L.M., M.R.W., P.H., S.P., A.F.D., R.M.T., J.D.); and Charité - Universitätsmedizin Berlin, Berlin, Germany (J.S.).
authors: Anna F
authors: AF
authors: Dominiczak
authors: From the Institute of Cardiovascular and Medical Sciences, School of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom (R.L.M., M.R.W., P.H., S.P., A.F.D., R.M.T., J.D.); and Charité - Universitätsmedizin Berlin, Berlin, Germany (J.S.).
authors: Rhian M
authors: RM
authors: Touyz
authors: From the Institute of Cardiovascular and Medical Sciences, School of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom (R.L.M., M.R.W., P.H., S.P., A.F.D., R.M.T., J.D.); and Charité - Universitätsmedizin Berlin, Berlin, Germany (J.S.).
authors: Jesse
authors: J
authors: Dawson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000493:Allopurinol / Q000008:administration & dosage*; D000963:Antimetabolites / Q000008:administration & dosage; D001794:Blood Pressure / Q000187:drug effects / Q000502:physiology*; D004305:Dose-Response Relationship, Drug; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology* / Q000209:etiology; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology* / Q000209:etiology; D006113:United Kingdom / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000963:Antimetabolites; D000493:Allopurinol
keywords: allopurinol; blood pressure; hypertension; prevention & control; stroke