| 1. |
- Lindberg, Gunnar, et al.
(författare)
-
Use of calcium channel blockers as antihypertensives in relation to mortality and cancer incidence: a population-based observational study
- 2002
-
Ingår i: Pharmacoepidemiology and Drug Safety. - : Wiley. - 1053-8569. ; 11:6, s. 493-497
-
Tidskriftsartikel (refereegranskat)abstract
- Abstract Purpose Treatment with blood pressure lowering drugs may reduce morbidity and mortality. However, the efficacy and effectiveness may differ between antihypertensive agents. The current investigation aimed to compare mortality and cancer incidence in hypertensive patients treated with calcium channel blockers (CCB) or with other antihypertensive drugs (AHD). Methods All patients in two outpatient clinics treated with AHD who underwent an annual check-up during 1989 or 1990 were selected. Fatal events were identified through 1997 and incident cancers through 1998. Results Two hundred and fourteen patients on CCB and 1029 on other AHD were identified. Overall mortality and the combined mortality from myocardial infarction and stroke were higher in CCB users; hazard ratios adjusted for sex, age, co-morbidity and other and risk factors were 1.84 (95% CI 1.25-2.72) and 2.37 (95% CI 1.27-4.44), respectively. The risk estimates for cancer mortality and for cancer incidence did not differ significantly. Conclusions Results from clinical trials as well as observational studies, including the present one, indicate a higher mortality risk and a higher cardiovascular morbidity risk associated with use of CCB. Accordingly, CCB should not be regarded as first line drugs in hypertension.
|
|
| 2. |
|
|
| 3. |
|
|
| 4. |
- Merlo, Juan, et al.
(författare)
-
Incidence of myocardial infarction in elderly men being treated with antihypertensive drugs: population based cohort study
- 1996
-
Ingår i: BMJ. - 0959-8138. ; 313:7055, s. 457-461
-
Tidskriftsartikel (refereegranskat)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 < or = 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 < or = 90 mm Hg.
|
|
| 5. |
|
|
| 6. |
- Merlo, Juan, et al.
(författare)
-
Utilization of cardiovascular drugs (blood pressure lowering drugs, lipid lowering drugs and nitrates) and mortality from ischaemic heart disease and stroke. An ecological analysis based on Sweden's municipalities
- 1999
-
Ingår i: European Journal of Clinical Pharmacology. - : Springer Science and Business Media LLC. - 1432-1041 .- 0031-6970. ; 55:1, s. 69-76
-
Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To perform an ecological study in an effort to generate questions concerning the preventive impact of various cardiovascular drugs on mortality from stroke and ischaemic heart disease (IHD) in the community, and to explore the association between sales of nitrates and mortality from stroke and IHD. METHODS: Out-patient drug utilization (sales) of blood pressure lowering drugs, lipid lowering drugs and nitrates were categorized in four groups of equal size by quartiles and compared with mortality from IHD and stroke, using the group of municipalities with the lowest utilization as reference, from 1989 to 1993 in 283 of Sweden's 288 municipalities, by Poisson regression. Adjustments were made for population size, age and gender proportions, the utilization rate of cardiovascular drugs other than the tested drug group and location of the municipality. RESULTS: Compared with the group of municipalities with the lowest sales and adjusting only for population size, mortality from IHD and stroke increased with the extent of utilization of blood pressure lowering drugs and nitrates. In contrast, mortality decreased with increased utilization of lipid lowering drugs. After further adjustments by percentage of men, age structure, geographical location (mid-points) of the municipalities, and, as a proxy for cardiovascular disease, the sales of cardiovascular drugs other than the tested drug group, the increased risk associated with blood pressure lowering drugs disappeared, and there was a dose-response association between sales of diuretics and old antihypertensives and decreasing mortality, sales of nitrates continued to be associated with an increased risk, and the low mortality risk associated with sales of lipid lowering drugs persisted. CONCLUSION: Lipid lowering drugs may have a preventive impact in the general population, but the preventive impact of blood pressure lowering drugs, with the exception of diuretics and old antihypertensives, may be low in many municipalities. The safety of nitrates needs more investigation at the individual level.
|
|
