Risk of acute myocardial infarction after discontinuation of antihypertensive agents: a case–control study

Abstract

We performed a nested case-control study in a cohort of antihypertensive drug users to assess the association between discontinuation of different antihypertensive agents and the risk of acute myocardial infarction (AMI). Cases and controls were drawn from the Utrecht Cardiovascular Pharmacogenetics database. Patients who were hospitalised for their first AMI were considered cases and controls were not hospitalised for AMI. Antihypertensive users were defined as current users if the index date (date of AMI) fell within the prescribed duration or as discontinuers if this date fell outside the prescribed duration. According to the recency of discontinuation, discontinuers were divided into the following: recent discontinuers (⩽90 days), intermediate-term discontinuers (91-180 days) and long-term discontinuers (>180 days). We found that the risk of AMI was significantly increased in discontinuers, regardless of time since discontinuation, of beta-blockers (adjusted odds ratio (OR) 1.54; 95% confidence interval (CI; 1.25-1.91), P-value<0.0005), calcium channel blockers (CCBs; adjusted OR 2.25; 95% CI (1.53-3.30), P-value<0.0005) and diuretics (adjusted OR 1.76; 95% CI (1.24-2.48), P-value=0.002) compared to current users of these drugs. Moreover, the risk of AMI was significantly increased in long-term discontinuers (beta-blockers, CCBs, angiotensin-converting enzyme inhibitors and diuretics) and intermediate-term discontinuers (beta-blockers and CCBs) versus current users of these drugs. There was no difference in AMI risk between recent discontinuers of antihypertensive drugs versus current users of these drugs. In conclusion, discontinuation of antihypertensive drugs increases the risk of AMI after >90 days of discontinuation. This further underlines the importance of persistence to antihypertensive drug therapy to reduce the risk of AMI in patients with hypertension.

Persistence to Antihypertensive and Clinical Outcomes in Acute Coronary Syndrome Patients after Percutaneous Coronary Intervention

“…This study is in line with a study by Corrao et al (2017), which proved that continuous use of antihypertensive drugs would reduce the risk of cardiovascular events compared to patients who discontinue antihypertensive use (Corrao et al, 2017). A Dutch study is also in line with this study, where the results show a link between the discontinuation of antihypertensive drugs with the incidence of acute myocardial infarction, and this association is significant, especially for betablockers drugs, calcium antagonists, and diuretics (Alharbi et al, 2017). Patients at the Cardiology Department of Spedali Civili of Brescia, Italy, who were treated at discharge with at least 50% of the target dose of ACEi/ARBs and or beta-blockers showed an independent lower risk of all-cause death and heart failure (HF) rehospitalization (Carubelli et al, 2021).…”

COVID-19 e Eventos Coronários Agudos – Danos Colaterais. Um Relato de Caso

“…Apesar de não podermos definir um nexo causal entre a suspensão e a ocorrência do IAM, sabe-se que a descontinuação de medicações anti-hipertensivas pode contribuir para a maior ocorrência SCA . 9 A enzima conversora de angiotensina do tipo 2 (ECA-2) parece estar imbricada no mecanismo de internalização do SARS-CoV-2 a nível tecidual. Esta informação gerou especulações de que usuários de inibidores da enzima conversora de angiotensina (IECA) ou de BRA pudessem ter maior chance de infectar-se devido a upregulation da ECA-2.…”