Association Between Various Drugs Used for Hypertension and Risk of Acute Myocardial Infarction

Abstract

We examined the relation between various drugs used for treating high blood pressure and the incidence of acute myocardial infarction with a case-control design. Four hospitals taking care of all patients in Oslo with acute myocardial infarction participated with a total of 95 hypertensive men and women under 75 years of age who had had an acute myocardial infarction. A total of 329 age and sex matched controls were hypertensive citizens in Oslo without myocardial infarction. Frequency of treatment with drugs and odds ratio of risks with these drugs were calculated. The risk (odds ratio) of myocardial infarction for drug treatment during the last five years versus non drug treatment was 0.70 (95% confidence interval 0.42-1.18). The risk for diuretics and beta-blockers tested against no treatment was 0.91 (0.52-1.61). The corresponding risk for vasodilating drugs was 0.43 (0.20-0.91). Four weeks of exposure to alpha-blockers, on the other hand, tested against other drug treatments, indicated an odds ratio of 4.62 (1.01-24.0) for individuals with a history of angina. These data confirm that treatment with diuretics and beta-blockers has only little effect on the incidence of myocardial infarction. As a whole, vasodilators are associated with a significant reduction in this incidence, but alpha-blockers enhance the risk in patients with angina.

Primary Prevention of Cardiovascular Disease

“…small size, lack of details essential to the interpretation of the data, multiple comparisons of the same data base) that further detract from the conclu sions. Finally, the results of these studies have not been confirmed by other observational or case-control studies sometimes on much larger populations [30][31][32], They have also not been confirmed by recent prospective stud ies [33][34][35], One of them, the Shanghai Trial of Nifedi pine in the Elderly concerns long-term administration of nifedipine in Chinese elderly hypertensive subjects [35]. As shown in figure 2, in this single-blind multicenter study the nifedipine-treated group showed a significantly greater reduction in blood pressure than the placebotreated group.…”

The Calcium Channel Blocker Controversy in Perspective

“…whereas according to Pahor et al [19] the mortality risk was higher with calcium antagonists than with P-blockers; finally, the risk of myocardial infarction was greater with verapamil than with P-blockers in the study by Psaty et al [18], whereas this risk was not as great with verapamil as with P-blockers in the study by Pahor et al [ 19]. Another case-control study by Aursnes et al [20] per formed in Norway reached exactly the opposite conclu sions to those of the papers by Psaty et al [ 18] and Pahor et al [19]. As illustrated in table 3, the Norwegian authors calculated a lower risk of myocardial infarction in hyper tensive patients treated with calcium antagonists than in patients treated with conventional antihypertensive drugs.…”

“…Also published in 1995. a meta-analysis of studies in which short-acting nifedipine was given to patients with ischaemic heart disease [21] was taken as supportive of the other studies suggesting an increased coronary risk with high nifedipine doses, but it should not be forgotten that this meta-analysis refers to an entirely different popu lation of patients from that considered in the studies by Psatv et al [ 18], Pahor et al [ 19] and Aursnes et al [20].…”

Effects of Calcium Antagonists on the Risks of Coronary Heart Disease, Cancer and Bleeding.

“…One of these studies observed an increased CHD risk in patients treated with a calcium antagonist (38) and two did not (39,40). Among those not reporting an increase in risk, one included about 200 cases and 800 controls (39) and the other included about 100 cases and 300 controls (40).…”