BMJ 1996;313:457-461 (24 August)

Papers

Incidence of myocardial infarction in elderly men being treated with antihypertensive drugs: population based cohort study

Juan Merlo, doctoral fellow,a Jonas Ranstam, biostatistician,b Hans Liedholm, senior registrar,a Bo Hedblad, epidemiologist,a Gunnar Lindberg, clinical epidemiologist,b Ulf Lindblad, research fellow,c Sven-Olof Isacsson, professor,a Arne Melander, professor,b Lennart Rastam, professor a

a Department of Community Medicine, Lund University, Malmo University Hospital, S-205 02 Malmo, Sweden, b NEPI Foundation (Swedish Network for Pharmacoepidemiology), Malmo and Stockholm, Sweden, c Skaraborg Institute, Skovde, Sweden

Correspondence to: Dr Merlo.

Abstract

Objective: To analyse the association between use of antihypertensive treatment, diastolic blood pressure, and long term incidence of ischaemic cardiac events in elderly men.
Design: Population based cohort study. Baseline examination in 1982-3 and follow up for up to 10 years.
Setting: Malmo, Sweden.
Subjects: 484 randomly selected men born in 1914 and living in Malmo during 1982.
Main outcome measures: Observational comparisons of incidence rates and rate and hazard ratios of ischaemic cardiac events (myocardial infarction or death due to chronic ischaemic cardiac disease).
Results: The crude incidence rate of ischaemic cardiac events was higher in those subjects who were taking antihypertensive drugs than in those who were not (rate ratio 2.6 (95% confidence interval 1.7 to 3.9)). After adjustment for potential confounders (differences in baseline smoking habits, blood pressure, time since diagnosis of hypertension, ischaemic or other cardiovascular disease, hypercholesterolaemia, hypertriglyceridaemia, diabetes mellitus, obesity, and raised serum creatinine concentration) this rate was reduced but still raised (hazard ratio 1.9 (1.0 to 3.7)). In men with diastolic blood pressure >90 mm Hg, antihypertensive treatment was associated with a twofold increase in the incidence of ischaemic cardiac events (rate ratio 2.0 (1.1 to 3.6)), which vanished after adjustment for potential confounders (hazard ratio 1.1 (0.5 to 2.6)). In those subjects with diastolic blood pressure </=90 mm Hg, antihypertensive treatment was associated with fourfold increase in incidence (rate ratio 3.9 (2.1 to 7.1)), which remained after adjustment for potential confounders (hazard ratio 3.8 (1.3 to 11.0)).
Conclusion: Antihypertensive treatment may increase the risk of myocardial infarction in elderly men with treated diastolic blood pressures </=90 mm Hg.

Key messages

  • In our 10 year follow up of 484 elderly men the risk of an ischaemic cardiac event was higher in men who were taking antihypertensive drugs than in those who were not

  • Among men with diastolic blood pressure >90 mm Hg, the risk was increased twofold but disappeared when adjustments were made for other cardiovascular risk factors

  • Among those with diastolic blood pressure </=90 mm Hg, the risk associated with taking antihypertensive drugs was four times higher and remained after adjustment for other cardiovascular risk factors

  • These findings support the concept of a J shaped curve for risk of myocardial infarction in relation to treated diastolic blood pressure


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