Reactions 617 - 7 Sep 1996

Antihypertensive therapy mayincrease MI risk in some elderly

menAntihypertensive drug treatment may increase the risk

of ischaemic cardiac events* in elderly men with treateddiastolic BPs of ≤ 90mm Hg, say Dr Juan Merlo andcolleagues from Sweden.

The investigators conducted a population-basedcohort study of 484 elderly men, 113 of whom weretaking ≥ 1 antihypertensive drug(s), including diuretics,β-blockers, hydralazine, nifedipine, bethanidine,prazosin, methyldopa and reserpine. The men werefollowed for up to 10 years, with a total follow-up periodof 3842 person-years.

After adjustment for potential confounders, theincidence of ischaemic cardiac events was higher in menreceiving, than in those not receiving, antihypertensivedrug therapy (hazard ratio 1.9; 95% CI 1.0–3.7). In menwith a diastolic BP ≤ 90mm Hg, antihypertensive usewas associated with an almost 4-fold increase in the rateof ischaemic cardiac events after adjustment forpotential confounders (hazard ratio 3.8; 95% CI1.3–11.0).

In men with a diastolic BP ≥ 90mm Hg,antihypertensive drug use was associated with a 2-foldincrease in the incidence of ischaemic cardiac events inunadjusted analyses. However, after adjustment forpotential confounders, the hazard ratio was reduced to1.1 (95% CI 0.5–2.6).

According to Dr Merlo and colleagues, their findingsare consistent with the J-shaped curve theory, in thatlowering BP below a certain level increases the risk ofMI.* Ischaemic cardiac events included myocardial infarction or death dueto chronic ischaemic cardiac disease.

Merlo J, et al. Incidence of myocardial infarction in elderly men being treated withantihypertensive drugs: population based cohort study. BMJ 313: 457-461, 24 Aug1996 800468242

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Reactions 7 Sep 1996 No. 6170114-9954/10/0617-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved