Association between cardiovascular outcomes and antihypertensive drug treatment in older women

Sylvia Wassertheil-Smoller, Bruce Psaty, Philip Greenland, Albert Oberman, Theodore Kotchen, Charles Mouton, Henry Black, Aaron Aragaki, Maurizio Trevisan

Research output: Contribution to journalArticle

86 Citations (Scopus)

Abstract

Context: Diuretic-based therapy is at least as effective as newer classes of agents for hypertension. However, many patients with hypertension require treatment with more than 1 drug class to achieve blood pressure control. The relative benefits or risks of 2-drug-class combinations are not well known. Objective: To prospectively evaluate if there are differences in cardiovascular mortality among postmenopausal women with hypertension but no history of cardiovascular disease (CVD) treated with different classes of antihypertensive agents, singly or in combination. Design, Setting, and Participants: Women with hypertension enrolled in the Women's Health Initiative Observational Study, a longitudinal multicenter cohort study of 93 676 women aged 50 to 79 years at baseline (1994-1998), assessed for a mean of 5.9 years. Main Outcome Measures: Relationship between baseline use of ACE inhibitors, β-blockers, calcium channel blockers, or diuretics, or a combination of these, and incidence of coronary heart disease, stroke, and CVD mortality. Results: Among 30219 women with hypertension but no history of CVD, 11 294 (57%) were receiving monotherapy with an ACE inhibitor, β-blocker, calcium channel blocker, or diuretic, and 4493 (23%) were treated at baseline with a combination of diuretic plus either ACE inhibitor, β-blocker, or calcium channel blocker or ACE inhibitor plus calcium channel blocker. Monotherapy with calcium channel blockers vs diuretics was associated with greater risk of CVD death (hazard ratio, 1.55; 95% confidence interval, 1.02-2.35), controlling for multiple covariates. Women treated with a diuretic plus a calcium channel blocker had an 85% greater risk of CVD death vs those treated with a diuretic plus a β-blocker, after adjustment for age, race, smoking, high cholesterol levels requiring medication, body mass index, physical activity, use of hormone therapy, and diabetes. After exclusion of women with diabetes the hazard ratio was 2.16 (95% confidence interval, 1.16-4.03). Analyses adjusting for propensity to be receiving a particular treatment did not change the results. For morbid events of coronary heart disease or stroke, diuretics plus ACE inhibitors or calcium channel blockers did not differ from diuretics plus β-blockers. Conclusions: Among women with hypertension but no history of CVD, a 2-drug-class regimen of calcium channel blockers plus diuretics was associated with a higher risk of CVD mortality vs β-blockers plus diuretics. Risks were similar for ACE inhibitors plus diuretics and β-blockers plus diuretics. Monotherapy with diuretics was equal or superior to other monotherapy in preventing CVD complications of high blood pressure.

Original languageEnglish (US)
Pages (from-to)2849-2859
Number of pages11
JournalJournal of the American Medical Association
Volume292
Issue number23
DOIs
StatePublished - Dec 15 2004
Externally publishedYes

Fingerprint

Cardiovascular Agents
Diuretics
Antihypertensive Agents
Calcium Channel Blockers
Cardiovascular Diseases
Angiotensin-Converting Enzyme Inhibitors
Hypertension
Therapeutics
Coronary Disease
Mortality
Stroke
Confidence Intervals
Women's Health
Drug Combinations
Hypercholesterolemia
Pharmaceutical Preparations
Multicenter Studies

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Wassertheil-Smoller, S., Psaty, B., Greenland, P., Oberman, A., Kotchen, T., Mouton, C., ... Trevisan, M. (2004). Association between cardiovascular outcomes and antihypertensive drug treatment in older women. Journal of the American Medical Association, 292(23), 2849-2859. https://doi.org/10.1001/jama.292.23.2849

Association between cardiovascular outcomes and antihypertensive drug treatment in older women. / Wassertheil-Smoller, Sylvia; Psaty, Bruce; Greenland, Philip; Oberman, Albert; Kotchen, Theodore; Mouton, Charles; Black, Henry; Aragaki, Aaron; Trevisan, Maurizio.

In: Journal of the American Medical Association, Vol. 292, No. 23, 15.12.2004, p. 2849-2859.

Research output: Contribution to journalArticle

Wassertheil-Smoller, S, Psaty, B, Greenland, P, Oberman, A, Kotchen, T, Mouton, C, Black, H, Aragaki, A & Trevisan, M 2004, 'Association between cardiovascular outcomes and antihypertensive drug treatment in older women', Journal of the American Medical Association, vol. 292, no. 23, pp. 2849-2859. https://doi.org/10.1001/jama.292.23.2849
Wassertheil-Smoller, Sylvia ; Psaty, Bruce ; Greenland, Philip ; Oberman, Albert ; Kotchen, Theodore ; Mouton, Charles ; Black, Henry ; Aragaki, Aaron ; Trevisan, Maurizio. / Association between cardiovascular outcomes and antihypertensive drug treatment in older women. In: Journal of the American Medical Association. 2004 ; Vol. 292, No. 23. pp. 2849-2859.
@article{02c05ee4aa384ffa9bc7d77eb8c3f780,
title = "Association between cardiovascular outcomes and antihypertensive drug treatment in older women",
abstract = "Context: Diuretic-based therapy is at least as effective as newer classes of agents for hypertension. However, many patients with hypertension require treatment with more than 1 drug class to achieve blood pressure control. The relative benefits or risks of 2-drug-class combinations are not well known. Objective: To prospectively evaluate if there are differences in cardiovascular mortality among postmenopausal women with hypertension but no history of cardiovascular disease (CVD) treated with different classes of antihypertensive agents, singly or in combination. Design, Setting, and Participants: Women with hypertension enrolled in the Women's Health Initiative Observational Study, a longitudinal multicenter cohort study of 93 676 women aged 50 to 79 years at baseline (1994-1998), assessed for a mean of 5.9 years. Main Outcome Measures: Relationship between baseline use of ACE inhibitors, β-blockers, calcium channel blockers, or diuretics, or a combination of these, and incidence of coronary heart disease, stroke, and CVD mortality. Results: Among 30219 women with hypertension but no history of CVD, 11 294 (57{\%}) were receiving monotherapy with an ACE inhibitor, β-blocker, calcium channel blocker, or diuretic, and 4493 (23{\%}) were treated at baseline with a combination of diuretic plus either ACE inhibitor, β-blocker, or calcium channel blocker or ACE inhibitor plus calcium channel blocker. Monotherapy with calcium channel blockers vs diuretics was associated with greater risk of CVD death (hazard ratio, 1.55; 95{\%} confidence interval, 1.02-2.35), controlling for multiple covariates. Women treated with a diuretic plus a calcium channel blocker had an 85{\%} greater risk of CVD death vs those treated with a diuretic plus a β-blocker, after adjustment for age, race, smoking, high cholesterol levels requiring medication, body mass index, physical activity, use of hormone therapy, and diabetes. After exclusion of women with diabetes the hazard ratio was 2.16 (95{\%} confidence interval, 1.16-4.03). Analyses adjusting for propensity to be receiving a particular treatment did not change the results. For morbid events of coronary heart disease or stroke, diuretics plus ACE inhibitors or calcium channel blockers did not differ from diuretics plus β-blockers. Conclusions: Among women with hypertension but no history of CVD, a 2-drug-class regimen of calcium channel blockers plus diuretics was associated with a higher risk of CVD mortality vs β-blockers plus diuretics. Risks were similar for ACE inhibitors plus diuretics and β-blockers plus diuretics. Monotherapy with diuretics was equal or superior to other monotherapy in preventing CVD complications of high blood pressure.",
author = "Sylvia Wassertheil-Smoller and Bruce Psaty and Philip Greenland and Albert Oberman and Theodore Kotchen and Charles Mouton and Henry Black and Aaron Aragaki and Maurizio Trevisan",
year = "2004",
month = "12",
day = "15",
doi = "10.1001/jama.292.23.2849",
language = "English (US)",
volume = "292",
pages = "2849--2859",
journal = "JAMA - Journal of the American Medical Association",
issn = "0002-9955",
publisher = "American Medical Association",
number = "23",

}

TY - JOUR

T1 - Association between cardiovascular outcomes and antihypertensive drug treatment in older women

AU - Wassertheil-Smoller, Sylvia

AU - Psaty, Bruce

AU - Greenland, Philip

AU - Oberman, Albert

AU - Kotchen, Theodore

AU - Mouton, Charles

AU - Black, Henry

AU - Aragaki, Aaron

AU - Trevisan, Maurizio

PY - 2004/12/15

Y1 - 2004/12/15

N2 - Context: Diuretic-based therapy is at least as effective as newer classes of agents for hypertension. However, many patients with hypertension require treatment with more than 1 drug class to achieve blood pressure control. The relative benefits or risks of 2-drug-class combinations are not well known. Objective: To prospectively evaluate if there are differences in cardiovascular mortality among postmenopausal women with hypertension but no history of cardiovascular disease (CVD) treated with different classes of antihypertensive agents, singly or in combination. Design, Setting, and Participants: Women with hypertension enrolled in the Women's Health Initiative Observational Study, a longitudinal multicenter cohort study of 93 676 women aged 50 to 79 years at baseline (1994-1998), assessed for a mean of 5.9 years. Main Outcome Measures: Relationship between baseline use of ACE inhibitors, β-blockers, calcium channel blockers, or diuretics, or a combination of these, and incidence of coronary heart disease, stroke, and CVD mortality. Results: Among 30219 women with hypertension but no history of CVD, 11 294 (57%) were receiving monotherapy with an ACE inhibitor, β-blocker, calcium channel blocker, or diuretic, and 4493 (23%) were treated at baseline with a combination of diuretic plus either ACE inhibitor, β-blocker, or calcium channel blocker or ACE inhibitor plus calcium channel blocker. Monotherapy with calcium channel blockers vs diuretics was associated with greater risk of CVD death (hazard ratio, 1.55; 95% confidence interval, 1.02-2.35), controlling for multiple covariates. Women treated with a diuretic plus a calcium channel blocker had an 85% greater risk of CVD death vs those treated with a diuretic plus a β-blocker, after adjustment for age, race, smoking, high cholesterol levels requiring medication, body mass index, physical activity, use of hormone therapy, and diabetes. After exclusion of women with diabetes the hazard ratio was 2.16 (95% confidence interval, 1.16-4.03). Analyses adjusting for propensity to be receiving a particular treatment did not change the results. For morbid events of coronary heart disease or stroke, diuretics plus ACE inhibitors or calcium channel blockers did not differ from diuretics plus β-blockers. Conclusions: Among women with hypertension but no history of CVD, a 2-drug-class regimen of calcium channel blockers plus diuretics was associated with a higher risk of CVD mortality vs β-blockers plus diuretics. Risks were similar for ACE inhibitors plus diuretics and β-blockers plus diuretics. Monotherapy with diuretics was equal or superior to other monotherapy in preventing CVD complications of high blood pressure.

AB - Context: Diuretic-based therapy is at least as effective as newer classes of agents for hypertension. However, many patients with hypertension require treatment with more than 1 drug class to achieve blood pressure control. The relative benefits or risks of 2-drug-class combinations are not well known. Objective: To prospectively evaluate if there are differences in cardiovascular mortality among postmenopausal women with hypertension but no history of cardiovascular disease (CVD) treated with different classes of antihypertensive agents, singly or in combination. Design, Setting, and Participants: Women with hypertension enrolled in the Women's Health Initiative Observational Study, a longitudinal multicenter cohort study of 93 676 women aged 50 to 79 years at baseline (1994-1998), assessed for a mean of 5.9 years. Main Outcome Measures: Relationship between baseline use of ACE inhibitors, β-blockers, calcium channel blockers, or diuretics, or a combination of these, and incidence of coronary heart disease, stroke, and CVD mortality. Results: Among 30219 women with hypertension but no history of CVD, 11 294 (57%) were receiving monotherapy with an ACE inhibitor, β-blocker, calcium channel blocker, or diuretic, and 4493 (23%) were treated at baseline with a combination of diuretic plus either ACE inhibitor, β-blocker, or calcium channel blocker or ACE inhibitor plus calcium channel blocker. Monotherapy with calcium channel blockers vs diuretics was associated with greater risk of CVD death (hazard ratio, 1.55; 95% confidence interval, 1.02-2.35), controlling for multiple covariates. Women treated with a diuretic plus a calcium channel blocker had an 85% greater risk of CVD death vs those treated with a diuretic plus a β-blocker, after adjustment for age, race, smoking, high cholesterol levels requiring medication, body mass index, physical activity, use of hormone therapy, and diabetes. After exclusion of women with diabetes the hazard ratio was 2.16 (95% confidence interval, 1.16-4.03). Analyses adjusting for propensity to be receiving a particular treatment did not change the results. For morbid events of coronary heart disease or stroke, diuretics plus ACE inhibitors or calcium channel blockers did not differ from diuretics plus β-blockers. Conclusions: Among women with hypertension but no history of CVD, a 2-drug-class regimen of calcium channel blockers plus diuretics was associated with a higher risk of CVD mortality vs β-blockers plus diuretics. Risks were similar for ACE inhibitors plus diuretics and β-blockers plus diuretics. Monotherapy with diuretics was equal or superior to other monotherapy in preventing CVD complications of high blood pressure.

UR - http://www.scopus.com/inward/record.url?scp=10344262902&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=10344262902&partnerID=8YFLogxK

U2 - 10.1001/jama.292.23.2849

DO - 10.1001/jama.292.23.2849

M3 - Article

C2 - 15598916

AN - SCOPUS:10344262902

VL - 292

SP - 2849

EP - 2859

JO - JAMA - Journal of the American Medical Association

JF - JAMA - Journal of the American Medical Association

SN - 0002-9955

IS - 23

ER -