LONG-TERM SURVIVAL AND USE OF ANTIHYPERTENSIVE MEDICATIONS IN OLDER PERSONS

OBJECTIVE: To determine whether older persons with hypertension who us e specific calcium antagonists and ACE inhibitors have a different ris k of mortality than those using beta-blockers. DESIGN: A prospective c ohort study continuing from 1988 through 1992. SETTING: Three communit ies of the Established Populations for Epidemiologic Studies of the El derly. PARTICIPANTS: Hypertensive participants aged greater than or eq ual to 71 years (n = 906) who had no evidence of congestive heart fail ure and who were using either beta-blockers (n = 515), verapamil (n = 77), diltiazem (n = 92), nifedipine (n = 74), or ACE inhibitors (n = 1 48). Nifedipine was of the short acting variety. MEASUREMENTS: The mai n outcome measure was all-cause mortality. Age, gender, smoking, HDL-c holesterol, blood pressure, intake of digoxin and diuretics, physical disability, self-perceived health, and comorbid conditions were examin ed as confounders. RESULTS: During 3538 person-years of follow-up, 188 participants died (53 deaths per 1000 person-years). Compared with be ta-blockers, after adjusting for age, gender, comorbid conditions and other health-related factors, the relative risks (95% confidence inter val) for mortality associated with use of verapamil, diltiazem, nifedi pine, and ACE inhibitors were 0.8 (0.4-1.4), 1.3 (0.8-2.1), 1.7 (1.1-2 .7), and 0.9 (0.6-1.4), respectively. The results were unchanged after excluding participants with other potential contraindications to beta -blockers and after stratifying on coronary heart disease and use of d iuretics. Higher doses of nifedipine were associated with higher morta lity. CONCLUSION: Compared with beta-blockers, use of short acting nif edipine was associated with decreased survival in older hypertensive p ersons. However, selective factors influencing the use of specific dru gs in higher risk patients could not be completely discounted, and fin al conclusions will depend on clinical trials.