Key result
Compared with thiazide diuretics alone, use of ACE inhibitors (RR 2.79; 95% CI 1.47-5.27), calcium channel blockers, or beta-blockers was associated with a higher risk of first ischemic stroke.
Why the study?
Does single-drug therapy with beta-blockers, calcium channel blockers, or ACE inhibitors increase the risk of first ischemic stroke compared to thiazide diuretics in pharmacologically treated hypertensive patients?
Case-Control (n=3,170)
Does single-drug therapy with beta-blockers, calcium channel blockers, or ACE inhibitors increase the risk of first ischemic stroke compared to thiazide diuretics in pharmacologically treated hypertensive patients?
Relative Risk: 2.79 (95% CI 1.47–5.27)
In pharmacologically treated hypertensive patients without prior cardiovascular disease, single-drug therapy with beta-blockers, calcium channel blockers, or ACE inhibitors is associated with a higher risk of first ischemic stroke compared to thiazide diuretics alone.
May favor thiazide monotherapy for stroke prevention in hypertension; leaves open confirmation in randomized trials.
BACKGROUND: The relative effectiveness of various antihypertensive drugs with regard to the reduction of stroke incidence remains uncertain. OBJECTIVE: To assess the association between first ischemic stroke and use of antihypertensive drugs. METHODS: A population-based case-control study was performed among enrollees of the Group Health Cooperative of Puget Sound. Case patients included pharmacologically treated hypertensive patients who sustained a first ischemic stroke (fatal or nonfatal; n = 380) between July 1, 1989, and December 31, 1996. Control subjects were a random sample of treated hypertensive enrollees without a history of a stroke (n = 2790). Medical record review and a telephone interview of consenting survivors were used to collect information on risk factors for stroke. Computerized pharmacy records were used to assess antihypertensive drug use. RESULTS: Among 1237 single-drug users with no history of cardiovascular disease, the adjusted risk of ischemic stroke was higher among users of a beta-blocker (risk ratio [RR], 2.03; 95% confidence interval [CI], 1.05-3.94), calcium channel blocker (RR, 2.30; 95% CI, 1.16-4.56), or angiotensin-converting enzyme inhibitor (RR, 2.79; 95% CI, 1.47-5. 27) than among users of a thiazide diuretic alone. Among 673 single-drug users with a history of cardiovascular disease, the RRs were 1.22 (95% CI, 0.63-2.35), 1.18 (95% CI, 0.59-2.33), and 1.45 (95% CI, 0.70-3.02) among users of a beta-blocker, calcium channel blocker, and angiotensin-converting enzyme inhibitor, respectively, compared with users of a thiazide diuretic alone. CONCLUSIONS: In this study of pharmacologically treated hypertensive patients, antihypertensive drug regimens that did not include a thiazide diuretic were associated with an increased risk of ischemic stroke compared with regimens that did include a thiazide. These results support the use of thiazide diuretics as first-line antihypertensive agents.
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Klungel et al. (2001) conducted a case-control in Hypertension (n=3,170). Non-thiazide antihypertensives (beta-blockers, calcium channel blockers, ACE inhibitors) vs. Thiazide diuretic alone was evaluated on First ischemic stroke (RR 2.79, 95% CI 1.47-5.27). Compared with thiazide diuretics alone, use of ACE inhibitors (RR 2.79; 95% CI 1.47-5.27), calcium channel blockers, or beta-blockers was associated with a higher risk of first ischemic stroke.
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