Key result
Antihypertensive drug use is linked to ~60% higher total coronary risk in middle-aged men.
Why the study?
It is important to evaluate the residual coronary risk of individuals treated with antihypertensive and lipid-lowering drugs at the population level, accounting for achieved risk factor levels.
Does the use of antihypertensive and lipid-lowering drugs affect residual coronary risk in middle-aged men free of baseline coronary heart disease?
Cohort (n=10,000)
Yes
Does the use of antihypertensive and lipid-lowering drugs affect residual coronary risk in middle-aged men free of baseline coronary heart disease?
Relative Risk: 1.6 (95% CI 1.18–2.16)
In middle-aged men, treatment with antihypertensive agents (particularly beta-blockers and calcium channel antagonists) is associated with a sizeable residual coronary risk, highlighting the need to consider this in cardiovascular risk assessments.
Antihypertensive use was associated with higher residual coronary risk; leaves open confounding versus causal effects in observational cohorts.
OBJECTIVE: Since the proportion of subjects taking antihypertensive and lipid-lowering drugs is currently increasing in industrialized countries, it is important to evaluate, at the population level, coronary risk of treated individuals, while taking into account the achieved level of their risk factors (i.e. their 'residual coronary risk'). DESIGN AND METHODS: We used the data from the Prospective Study of Myocardial Infarction (PRIME), which involved populations from France (three centres) and Northern Ireland (one centre) (in each centre, 2500 men, aged 50-59 years, free of coronary heart disease, with a 5-year follow-up), to analyse the relationships between cardiovascular drug use and subsequent coronary risk. RESULTS: Antihypertensive drug use was significantly positively associated (relative risk = 1.60; 95% confidence interval, 1.18-2.16) with total coronary risk, but not lipid-lowering drug use (relative risk = 1.15; 95% confidence interval, 0.77-1.73), while adjusting on classical risk factor levels (age, smoking, total cholesterol, high-density lipoprotein-cholesterol and systolic blood pressure). Subgroup analysis showed that these results applied to beta-blockers and calcium channel antagonists, but not to diuretics and angiotensin-converting enzyme inhibitors, to both angina pectoris and hard coronary event risk, but in the French population only and not in Belfast. Although the PRIME study was not designed to test the ability of different drugs to prevent coronary heart disease, this analysis raises the hypothesis that antihypertensive drugs could be associated with a sizeable residual coronary risk in middle-aged men. CONCLUSION: Treatment with antihypertensive agents, beta-blockers and calcium channel antagonists in particular, was associated with a sizeable residual coronary risk. It seems, therefore, important to consider antihypertensive treatment in the cardiovascular risk assessment of individuals.
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Blacher et al. (2004) conducted a cohort in Hypertension and hyperlipidaemia (n=10,000). Antihypertensive drug use vs. No antihypertensive drug use was evaluated on Total coronary risk (RR 1.60, 95% CI 1.18-2.16). Antihypertensive drug use was significantly associated with an increased total coronary risk (RR 1.60; 95% CI 1.18-2.16) in middle-aged men.
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