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 pharmacologically 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 beta-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 beta-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.
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 pharmacologically treated hypertensivepatients 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 beta-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 beta-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 hypertensivepatients, 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.
Authors: Bradford B Worrall; Karen C Johnston; Gail Kongable; Elena Hung; DeJuran Richardson; Philip B Gorelick Journal: Stroke Date: 2002-04 Impact factor: 7.914
Authors: Evan L Thacker; Kerri L Wiggins; Kenneth M Rice; W T Longstreth; Joshua C Bis; Sascha Dublin; Nicholas L Smith; Susan R Heckbert; Bruce M Psaty Journal: Stroke Date: 2009-12-03 Impact factor: 7.914
Authors: Nicole Lüneburg; Wolfgang Lieb; Tanja Zeller; Ming-Huei Chen; Renke Maas; Angela M Carter; Vanessa Xanthakis; Nicole L Glazer; Edzard Schwedhelm; Sudha Seshadri; Mohammad Arfan Ikram; William T Longstreth; Myriam Fornage; Inke R König; Christina Loley; Francisco M Ojeda; Arne Schillert; Thomas J Wang; Heinrich Sticht; Anja Kittel; Jörg König; Emelia J Benjamin; Lisa M Sullivan; Isabel Bernges; Maike Anderssohn; Andreas Ziegler; Christian Gieger; Thomas Illig; Christa Meisinger; H-Erich Wichmann; Philipp S Wild; Heribert Schunkert; Bruce M Psaty; Kerri L Wiggins; Susan R Heckbert; Nicholas Smith; Karl Lackner; Kathryn L Lunetta; Stefan Blankenberg; Jeanette Erdmann; Thomas Munzel; Peter J Grant; Ramachandran S Vasan; Rainer H Böger Journal: Circ Cardiovasc Genet Date: 2014-09-21
Authors: James S Floyd; Kerri L Wiggins; Mark Christiansen; Sascha Dublin; William T Longstreth; Nicholas L Smith; Barbara McKnight; Susan R Heckbert; Noel S Weiss; Bruce M Psaty Journal: Pharmacoepidemiol Drug Saf Date: 2015-11-08 Impact factor: 2.890