Michels KB, Rosner BA, Manson JE, Stampfer MJ, Walker AM,
Willet WC, Hennekens CH
Antihypertensive medications and cardiovascular disease in a
large cohort of U.S. women
12th Annual ASH Meeting
Am J Hypertens
(Apr) 10:24A 1997
The relative risk of cardiovascular disease morbidity and mortality in
patients taking calcium channel blockers has been widely debated in
the last year. This study specifically looks at the relative risk of
various blood pressure medications including short acting calcium
channel blockers in a large cohort of women
14,476 hypertensive women enrolled in the prospective study "the
Nurses Health Study reported the use of one of the following
antihypertensive medications in 1988: thiazide diuretics TD,
beta-blockers BB, short acting calcium channel blockers CCB, or ACE
inhibitors ACE. Cardiovascular disease morbidity and mortality was
followed prospectively from 1988-1994. The relative risks of
documented fatal and nonfatal myocardial infarction and total
cardiovascular events according to medication status are presented.
Covariate analysis for relative risks are adjusted for history of
angina pectoris and diabetes prior to 1988 as well as alcohol intake,
smoking, body mass index, menopausal status, postmenopausal hormone
use, aspirin intake, cholesterol level and exercise.
The relative risk of myocardial infarction excluding prior MI
N=14,189 with 228 events, relative risk age adjusted (relative risk
covariate adjusted) TD 1.00(reference), BB 1.27 (1.28), CCB
2.43(1.66), ACE 1.61 (1.40), TD and BB 1.7 (1.46), CCB and TD or BB
3.53 (1.96), ACE and TD or BB 1.34 (1.12). Cardiovascular events
excluding prior cardiovascular disease age adjusted relative risk
(covariate adjusted relative risk) N=14,053 with 378 events. TD 1.0
(reference), BB 1.11 (1.13), CCB 1.76(1.35), ACE 1.26 (1.14), TD and
BB 1.37 (1.24), CCB and TD or BB 2.30 (1.53), ACE and TD or BB 1.45
(1.29).
Comment: These authors conclude that these results may suggest
an increased risk of cardiovascular disease among patients treated
with short acting CCB. They do point out that chance or confounding
indications can not be completely excluded. They also point out that
these were short acting CCB and the results may not relate to long
acting CCBs. It is important to note that the duration of treatment
with the medications is not reported. The change or continuation of
the initial medication is not recorded and could be a major
confounding issue. If taken as an intent to treat design then the
relative risk between medications is significant. This study further
points out the need for the multiple prospective studies of the newer
antihypertensive medications to evaluate the safety and relative risk
of cardiovascular disease. (Betsy Ripley, M.D., Medical College
of Virginia)
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12th Annual ASH Meeting
H: Special problems :
Women
H: Special problems :
Outcomes