Key result
Compared with beta-blockers, use of short-acting nifedipine in older hypertensive persons was associated with increased all-cause mortality (RR 1.7; 95% CI 1.1-2.7).
Why the study?
Do specific calcium antagonists or ACE inhibitors alter the risk of all-cause mortality compared to beta-blockers in older hypertensive persons?
Cohort (n=906)
Yes
Do specific calcium antagonists or ACE inhibitors alter the risk of all-cause mortality compared to beta-blockers in older hypertensive persons?
Effect estimate: RR 1.7 (95% CI 1.1-2.7)
In older hypertensive patients without heart failure, the use of short-acting nifedipine is associated with decreased survival compared to beta-blockers.
May warrant avoiding short-acting nifedipine in older hypertensives; leaves open effects of other calcium antagonists or ACE inhibitors.
OBJECTIVE: To determine whether older persons with hypertension who use specific calcium antagonists and ACE inhibitors have a different risk of mortality than those using beta-blockers. DESIGN: A prospective cohort study continuing from 1988 through 1992. SETTING: Three communities of the Established Populations for Epidemiologic Studies of the Elderly. PARTICIPANTS: Hypertensive participants aged > or = 71 years (n = 906) who had no evidence of congestive heart failure and who were using either beta-blockers (n = 515), verapamil (n = 77), diltiazem (n = 92), nifedipine (n = 74), or ACE inhibitors (n = 148). Nifedipine was of the short acting variety. MEASUREMENTS: The main outcome measure was all-cause mortality. Age, gender, smoking, HDL-cholesterol, blood pressure, intake of digoxin and diuretics, physical disability, self-perceived health, and comorbid conditions were examined as confounders. RESULTS: During 3538 person-years of follow-up, 188 participants died (53 deaths per 1000 person-years). Compared with beta-blockers, after adjusting for age, gender, comorbid conditions and other health-related factors, the relative risks (95% confidence interval) for mortality associated with use of verapamil, diltiazem, nifedipine, and ACE inhibitors were 0.8 (0.4-1.4), 1.3 (0.8-2.1), 1.7 (1.1-2.7), and 0.9 (0.6-1.4), respectively. The results were unchanged after excluding participants with other potential contraindications to beta-blockers and after stratifying on coronary heart disease and use of diuretics. Higher doses of nifedipine were associated with higher mortality. CONCLUSION: Compared with beta-blockers, use of short acting nifedipine was associated with decreased survival in older hypertensive persons. However, selective factors influencing the use of specific drugs in higher risk patients could not be completely discounted, and final conclusions will depend on clinical trials.
No takes yet. Share an insight, caveat, or question.
Pahor et al. (1995) conducted a cohort in Hypertension (n=906). Verapamil, diltiazem, short-acting nifedipine, or ACE inhibitors vs. Beta-blockers was evaluated on All-cause mortality (RR 1.7, 95% CI 1.1-2.7). Compared with beta-blockers, use of short-acting nifedipine in older hypertensive persons was associated with increased all-cause mortality (RR 1.7; 95% CI 1.1-2.7).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: