Antihypertensive drug therapies and the risk of ischemic stroke

Olaf H. Klungel, Susan R. Heckbert, W. T. Longstreth, Curt D. Furberg, Robert C. Kaplan, Nicholas L. Smith, Rozenn N. Lemaitre, Hubert G M Leufkens, Anthonius De Boer, Bruce M. Psaty

Research output: Contribution to journalArticle

63 Citations (Scopus)

Abstract

Background: The relative effectiveness of various antihypertensive drugs with regard to the reduction of stroke incidence remains uncertain. Objective: To assess the association between first ischemic stroke and use of antihypertensive drugs. Methods: A population-based case-control study was performed among enrollees of the Group Health Cooperative of Puget Sound. Case patients included pharmacologicaliy treated hypertensive patients who sustained a first ischemic stroke (fatal or nonfatal; n=380) between July 1, 1989, and December 31, 1996. Control subjects were a random sample of treated hypertensive enrollees without a history of a stroke (n = 2790) Medical record review and a telephone interview of consenting survivors were used to collect information on risk factors for stroke. Computerized pharmacy records were used to assess antihypertensive drug use. Results: Among 1237 single-drug users with no history of cardiovascular disease, the adjusted risk of ischemic stroke was higher among users of a β-blocker (risk ratio [RR], 2.03; 95% confidence interval [CI], 1.05-3.94), calcium channel blocker (RR, 2.30; 95% CI, 1.16-4.56), or angiotensin-converting enzyme inhibitor (RR, 2.79; 95% CI, 1.47-5.27) than among users of a thiazide diuretic alone. Among 673 single-drug users with a history of cardiovascular disease, the RRs were 1.22 (95% CI, 0.63-2.35), 1.18 (95% CI, 0.59-2.33), and 1.45 (95% CI, 0.70-3.02) among users of a β-blocker, calcium channel blocker, and angiotensin-converting enzyme inhibitor, respectively, compared with users of a thiazide diuretic alone. Conclusions: In this study of pharmacologically treated hypertensive patients, antihypertensive drug regimens that did not include a thiazide diuretic were associated with an increased risk of ischemic stroke compared with regimens that did include a thiazide. These results support the use of thiazide diuretics as first-line antihypertensive agents.

Original languageEnglish (US)
Pages (from-to)37-43
Number of pages7
JournalArchives of Internal Medicine
Volume161
Issue number1
StatePublished - Jan 8 2001
Externally publishedYes

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Antihypertensive Agents
Sodium Chloride Symporter Inhibitors
Stroke
Drug Therapy
Confidence Intervals
Odds Ratio
Calcium Channel Blockers
Drug Users
Angiotensin-Converting Enzyme Inhibitors
Cardiovascular Diseases
Thiazides
Medical Records
Survivors
Case-Control Studies
Interviews
Incidence
Health
Population

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Klungel, O. H., Heckbert, S. R., Longstreth, W. T., Furberg, C. D., Kaplan, R. C., Smith, N. L., ... Psaty, B. M. (2001). Antihypertensive drug therapies and the risk of ischemic stroke. Archives of Internal Medicine, 161(1), 37-43.

Antihypertensive drug therapies and the risk of ischemic stroke. / Klungel, Olaf H.; Heckbert, Susan R.; Longstreth, W. T.; Furberg, Curt D.; Kaplan, Robert C.; Smith, Nicholas L.; Lemaitre, Rozenn N.; Leufkens, Hubert G M; De Boer, Anthonius; Psaty, Bruce M.

In: Archives of Internal Medicine, Vol. 161, No. 1, 08.01.2001, p. 37-43.

Research output: Contribution to journalArticle

Klungel, OH, Heckbert, SR, Longstreth, WT, Furberg, CD, Kaplan, RC, Smith, NL, Lemaitre, RN, Leufkens, HGM, De Boer, A & Psaty, BM 2001, 'Antihypertensive drug therapies and the risk of ischemic stroke', Archives of Internal Medicine, vol. 161, no. 1, pp. 37-43.
Klungel OH, Heckbert SR, Longstreth WT, Furberg CD, Kaplan RC, Smith NL et al. Antihypertensive drug therapies and the risk of ischemic stroke. Archives of Internal Medicine. 2001 Jan 8;161(1):37-43.
Klungel, Olaf H. ; Heckbert, Susan R. ; Longstreth, W. T. ; Furberg, Curt D. ; Kaplan, Robert C. ; Smith, Nicholas L. ; Lemaitre, Rozenn N. ; Leufkens, Hubert G M ; De Boer, Anthonius ; Psaty, Bruce M. / Antihypertensive drug therapies and the risk of ischemic stroke. In: Archives of Internal Medicine. 2001 ; Vol. 161, No. 1. pp. 37-43.
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AU - Kaplan, Robert C.

AU - Smith, Nicholas L.

AU - Lemaitre, Rozenn N.

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