Antihypertensive Drug Use, Blood Pressure Variability, and Incident Stroke Risk in Older Adults Three-City Cohort Study

被引:18
|
作者
Tully, Phillip J. [1 ,2 ,7 ]
Debette, Stephanie [1 ,3 ,4 ]
Dartigues, Jean-Francois [5 ]
Helmer, Catherine [5 ]
Artero, Sylvaine [6 ]
Tzourio, Christophe [1 ,7 ]
机构
[1] Univ Bordeaux, Dept Neuroepidemiol, F-33076 Bordeaux, France
[2] Univ Adelaide, Sch Med, Discipline Med, Freemasons Fdn Ctr Mens Hlth, Adelaide, SA 5005, Australia
[3] Bordeaux Univ Hosp, Dept Neurol, Bordeaux, France
[4] Boston Univ, Sch Med, Framingham Heart Study, Dept Neurol, Boston, MA 02215 USA
[5] Univ Bordeaux, INSERM, U897, Dept Epidemiol & Biostat, F-33076 Bordeaux, France
[6] Univ Montpellier, La Colombiere Hosp, UM1, INSERM,U1061, F-34059 Montpellier, France
[7] INSERM, Dept Neuroepidemiol, UMR897, F-33000 Bordeaux, France
关键词
antihypertensive; blood pressure variability; hypertension; ischemic; stroke; TO-VISIT VARIABILITY; CARDIOVASCULAR OUTCOMES; PROGNOSTIC-SIGNIFICANCE; HEART-RATE; HYPERTENSION; PREVENTION; MORTALITY; IMPACT; HEMODYNAMICS; METAANALYSIS;
D O I
10.1161/STROKEAHA.115.012321
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Background and Purpose-The aim was to determine the association between antihypertensive drug class and incident stroke controlling for long-term blood pressure (BP) variability (BPV) in people aged 65 years. Methods-The sample included 5951 participants (median age 74 years, 60% women) taking at least 1 drug for hypertension (3727/5951) or with systolic BP >140 mm Hg or diastolic BP >90 mm Hg. Participants were evaluated for incident fatal and nonfatal stroke to 12 years follow-up. BPV was calculated with the coefficient of variation method and regressed against 9 antihypertensive drug classes (BPVreg). Hazard models were used to determine hazard ratios for incident stroke risk attributable to drug class, adjusted for BP, BPVreg, covariates, and delayed entry bias. Results-There were 273 incident strokes over a median of 9.1 years (interquartile range 6.4-10.4). Stroke risk was generally not reduced by BP-lowering drugs. Angiotensin receptor blockers (hazard ratio 1.56; 95% confidence interval 1.06-2.28; P=0.02) and -blockers (hazard ratio 1.41; 95% confidence interval 1.03-1.92; P=0.03) were associated with an increased total stroke risk. Angiotensin receptor blockers and -blockers were also associated with ischemic strokes after adjustment for systolic BPV. Diastolic BPV was associated with stroke risk in analyses stratified by systolic BP 140 to 160 mm Hg (per 0.10 increase in coefficient of variation, hazard ratio 1.59; 95% confidence interval 1.05-2.40; P=0.03). Conclusions-The angiotensin receptor blocker and -blocker drug classes were associated with incident stroke and ischemic stroke in older adults. BPV was generally not associated with incident stroke.
引用
收藏
页码:1194 / 1200
页数:7
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