title: Antihypertensive Drug Use, Blood Pressure Variability, and Incident Stroke Risk in Older Adults: Three-City Cohort Study.
abstract: The aim was to determine the association between antihypertensive drug class and incident stroke controlling for long-term blood pressure (BP) variability (BPV) in people aged ≥65 years.
  
  
  
  The sample included 5951 participants (median age 74 years, 60% women) taking at least 1 drug for hypertension (3727/5951) or with systolic BP >140 mm Hg or diastolic BP >90 mm Hg. Participants were evaluated for incident fatal and nonfatal stroke to 12 years follow-up. BPV was calculated with the coefficient of variation method and regressed against 9 antihypertensive drug classes (BPVreg). Hazard models were used to determine hazard ratios for incident stroke risk attributable to drug class, adjusted for BP, BPVreg, covariates, and delayed entry bias.
  
  
  
  There were 273 incident strokes over a median of 9.1 years (interquartile range 6.4-10.4). Stroke risk was generally not reduced by BP-lowering drugs. Angiotensin receptor blockers (hazard ratio 1.56; 95% confidence interval 1.06-2.28; P=0.02) and β-blockers (hazard ratio 1.41; 95% confidence interval 1.03-1.92; P=0.03) were associated with an increased total stroke risk. Angiotensin receptor blockers and β-blockers were also associated with ischemic strokes after adjustment for systolic BPV. Diastolic BPV was associated with stroke risk in analyses stratified by systolic BP 140 to 160 mm Hg (per 0.10 increase in coefficient of variation, hazard ratio 1.59; 95% confidence interval 1.05-2.40; P=0.03).
  
  
  
  The angiotensin receptor blocker and β-blocker drug classes were associated with incident stroke and ischemic stroke in older adults. BPV was generally not associated with incident stroke.
authors.affiliation: From the University of Bordeaux, Department of Neuroepidemiology, Bordeaux, France (P.J.T., S.D., C.T.); Freemasons Foundation Centre for Men's Health, Discipline of Medicine, School of Medicine, The University of Adelaide, Australia (P.J.T.); Department of Neurology, Bordeaux University Hospital, Bordeaux, France (S.D.); Department of Neurology, Framingham Heart Study, Boston University School of medicine, MA (S.D.); Department of Epidemiology and Biostatistics, Institut National de la Santé et de la Recherche Médicale U897, University of Bordeaux, Bordeaux, France (J.-F.D., C.H.); INSERM U1061, La Colombière Hospital, University of Montpellier UM1, Montpellier, France (S.A.); and INSERM, Department of Neuroepidemiology, UMR897, F-33000 Bordeaux, France (P.J.T., C.T.).
authors.forename: Phillip J
authors.initials: PJ
authors.lastname: Tully
authors.affiliation: From the University of Bordeaux, Department of Neuroepidemiology, Bordeaux, France (P.J.T., S.D., C.T.); Freemasons Foundation Centre for Men's Health, Discipline of Medicine, School of Medicine, The University of Adelaide, Australia (P.J.T.); Department of Neurology, Bordeaux University Hospital, Bordeaux, France (S.D.); Department of Neurology, Framingham Heart Study, Boston University School of medicine, MA (S.D.); Department of Epidemiology and Biostatistics, Institut National de la Santé et de la Recherche Médicale U897, University of Bordeaux, Bordeaux, France (J.-F.D., C.H.); INSERM U1061, La Colombière Hospital, University of Montpellier UM1, Montpellier, France (S.A.); and INSERM, Department of Neuroepidemiology, UMR897, F-33000 Bordeaux, France (P.J.T., C.T.).
authors.forename: Stephanie
authors.initials: S
authors.lastname: Debette
authors.affiliation: From the University of Bordeaux, Department of Neuroepidemiology, Bordeaux, France (P.J.T., S.D., C.T.); Freemasons Foundation Centre for Men's Health, Discipline of Medicine, School of Medicine, The University of Adelaide, Australia (P.J.T.); Department of Neurology, Bordeaux University Hospital, Bordeaux, France (S.D.); Department of Neurology, Framingham Heart Study, Boston University School of medicine, MA (S.D.); Department of Epidemiology and Biostatistics, Institut National de la Santé et de la Recherche Médicale U897, University of Bordeaux, Bordeaux, France (J.-F.D., C.H.); INSERM U1061, La Colombière Hospital, University of Montpellier UM1, Montpellier, France (S.A.); and INSERM, Department of Neuroepidemiology, UMR897, F-33000 Bordeaux, France (P.J.T., C.T.).
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Dartigues
authors.affiliation: From the University of Bordeaux, Department of Neuroepidemiology, Bordeaux, France (P.J.T., S.D., C.T.); Freemasons Foundation Centre for Men's Health, Discipline of Medicine, School of Medicine, The University of Adelaide, Australia (P.J.T.); Department of Neurology, Bordeaux University Hospital, Bordeaux, France (S.D.); Department of Neurology, Framingham Heart Study, Boston University School of medicine, MA (S.D.); Department of Epidemiology and Biostatistics, Institut National de la Santé et de la Recherche Médicale U897, University of Bordeaux, Bordeaux, France (J.-F.D., C.H.); INSERM U1061, La Colombière Hospital, University of Montpellier UM1, Montpellier, France (S.A.); and INSERM, Department of Neuroepidemiology, UMR897, F-33000 Bordeaux, France (P.J.T., C.T.).
authors.forename: Catherine
authors.initials: C
authors.lastname: Helmer
authors.affiliation: From the University of Bordeaux, Department of Neuroepidemiology, Bordeaux, France (P.J.T., S.D., C.T.); Freemasons Foundation Centre for Men's Health, Discipline of Medicine, School of Medicine, The University of Adelaide, Australia (P.J.T.); Department of Neurology, Bordeaux University Hospital, Bordeaux, France (S.D.); Department of Neurology, Framingham Heart Study, Boston University School of medicine, MA (S.D.); Department of Epidemiology and Biostatistics, Institut National de la Santé et de la Recherche Médicale U897, University of Bordeaux, Bordeaux, France (J.-F.D., C.H.); INSERM U1061, La Colombière Hospital, University of Montpellier UM1, Montpellier, France (S.A.); and INSERM, Department of Neuroepidemiology, UMR897, F-33000 Bordeaux, France (P.J.T., C.T.).
authors.forename: Sylvaine
authors.initials: S
authors.lastname: Artero
authors.affiliation: From the University of Bordeaux, Department of Neuroepidemiology, Bordeaux, France (P.J.T., S.D., C.T.); Freemasons Foundation Centre for Men's Health, Discipline of Medicine, School of Medicine, The University of Adelaide, Australia (P.J.T.); Department of Neurology, Bordeaux University Hospital, Bordeaux, France (S.D.); Department of Neurology, Framingham Heart Study, Boston University School of medicine, MA (S.D.); Department of Epidemiology and Biostatistics, Institut National de la Santé et de la Recherche Médicale U897, University of Bordeaux, Bordeaux, France (J.-F.D., C.H.); INSERM U1061, La Colombière Hospital, University of Montpellier UM1, Montpellier, France (S.A.); and INSERM, Department of Neuroepidemiology, UMR897, F-33000 Bordeaux, France (P.J.T., C.T.). christophe.tzourio@u-bordeaux.fr.
authors.forename: Christophe
authors.initials: C
authors.lastname: Tzourio
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000009:adverse effects*; D000368:Aged; D000369:Aged, 80 and over; D057911:Angiotensin Receptor Antagonists / Q000009:adverse effects*; D000959:Antihypertensive Agents / Q000009:adverse effects*; D001794:Blood Pressure / Q000187:drug effects*; D015331:Cohort Studies; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000453:epidemiology; D015994:Incidence; D008297:Male; D012306:Risk; D020521:Stroke / Q000139:chemically induced* / Q000453:epidemiology
chemical_list: D000319:Adrenergic beta-Antagonists; D057911:Angiotensin Receptor Antagonists; D000959:Antihypertensive Agents
keywords: antihypertensive; blood pressure variability; hypertension; ischemic; stroke