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Angiotensin Receptor Blockers Versus Calcium Channel Blockers for First-Line Antihypertensive Therapy and Survival in
Hisashi Noma1,2,3, Hiroshi Sunada3, Taiki Sugimoto4
1Department of Interdisciplinary Statistical Mathematics, The Institute of Statistical Mathematics, Tokyo, Japan.
Background:
Evidence guiding first-line antihypertensive drug choice in adults aged 75 years or older is limited, despite widespread use of angiotensin receptor blockers (ARBs) and calcium channel blockers (CCBs) in late older age.
Methods:
We conducted a target trial emulation using a new-user design in a nationwide linked healthcare claims database in Japan. Adults aged ≥ 75 years who had no prescription of either drug class in the preceding 12 months and initiated an ARB (n = 10,037) or a CCB (n = 19,785) were followed from treatment initiation. The primary outcome was all-cause mortality; secondary outcomes included hospitalization for heart failure, myocardial infarction, stroke, and major adverse cardiovascular events (MACE). Intention-to-treat effects were estimated using inverse probability of treatment and censoring weighting with pooled logistic regression models.
Results:
Among 29,822 patients, median follow-up was 4.0 years. During follow-up, 3487 deaths occurred. ARB therapy was associated with lower all-cause mortality than CCB therapy (hazard ratio [HR], 0.885; 95% CI, 0.823-0.951). The estimated 5-year risk of death was 12.7% for ARB users and 14.8% for CCB users (absolute risk difference, -2.1 percentage points; 95% CI, -3.1 to -1.0). ARB therapy was also associated with lower risks of heart failure hospitalization (HR, 0.843; 95% CI, 0.774-0.918), myocardial infarction (HR, 0.867; 95% CI, 0.795-0.945), stroke (HR, 0.931; 95% CI, 0.869-0.998), and MACE (HR, 0.889; 95% CI, 0.848-0.931). Associations were consistent across age subgroups, including adults aged ≥ 85 years.
Conclusion:
In adults aged 75 years or older, ARB-based antihypertensive therapy was associated with lower risks of mortality and cardiovascular events compared with CCB-based therapy. These findings suggest that first-line antihypertensive drug choice may have prognostic implications in late older age.
Insights
For older adults aged 75+, angiotensin receptor blockers (ARBs) showed lower mortality and cardiovascular event risks compared to calcium channel blockers (CCBs). This suggests ARBs may be a preferred first-line choice for this age group.
Area of Science:
- Cardiology
- Geriatrics
- Pharmacology
Background:
- Limited evidence exists for first-line antihypertensive drug selection in adults aged 75 years and older.
- Angiotensin receptor blockers (ARBs) and calcium channel blockers (CCBs) are commonly used in this demographic.
Purpose of the Study:
- To compare the effectiveness of ARB-based versus CCB-based antihypertensive therapy in adults aged 75 years or older.
- To evaluate the impact of first-line antihypertensive choice on mortality and cardiovascular events in the elderly.
Main Methods:
- A target trial emulation using a new-user design was conducted on a Japanese nationwide healthcare claims database.
- Adults aged ≥75 years initiating ARBs (n=10,037) or CCBs (n=19,785) were followed for outcomes including all-cause mortality and major adverse cardiovascular events (MACE).
- Inverse probability of treatment and censoring weighting was used to estimate intention-to-treat effects.
Main Results:
- ARB therapy was associated with significantly lower all-cause mortality compared to CCB therapy (HR, 0.885; 95% CI, 0.823-0.951).
- The estimated 5-year risk of death was 2.1 percentage points lower for ARB users than CCB users.
- ARB therapy also demonstrated reduced risks of hospitalization for heart failure, myocardial infarction, stroke, and MACE.
Conclusions:
- In adults aged 75 years and older, ARB-based antihypertensive therapy is linked to better outcomes regarding mortality and cardiovascular events than CCB-based therapy.
- The choice of first-line antihypertensive medication may significantly impact prognosis in the elderly population.
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