The aim was to determine the association between antihypertensive drug class and incident stroke controlling for long–term blood pressure (BP) variability (BPV) in people aged ≥65 years. The angiotensin receptor blocker and β–blocker drug classes were associated with incident stroke and ischemic stroke in older adults. BPV was generally not associated with incident stroke.
- The sample included 5951 participants (median age 74 years, 60% women) taking at least 1 drug for hypertension (3727/5951) or with systolic BP >140 mm Hg or diastolic BP >90 mm Hg.
- Participants were evaluated for incident fatal and nonfatal stroke to 12 years follow-up.
- BPV was calculated with the coefficient of variation method and regressed against 9 antihypertensive drug classes (BPVreg).
- Hazard models were used to determine hazard ratios for incident stroke risk attributable to drug class, adjusted for BP, BPVreg, covariates, and delayed entry bias.
- There were 273 incident strokes over a median of 9.1 years (interquartile range 6.4-10.4).
- Stroke risk was generally not reduced by BP-lowering drugs.
- Angiotensin receptor blockers (hazard ratio 1.56; 95% confidence interval 1.06-2.28; P=0.02) and β-blockers (hazard ratio 1.41; 95% confidence interval 1.03-1.92; P=0.03) were associated with an increased total stroke risk.
- Angiotensin receptor blockers and β-blockers were also associated with ischemic strokes after adjustment for systolic BPV.
- Diastolic BPV was associated with stroke risk in analyses stratified by systolic BP 140 to 160 mm Hg (per 0.10 increase in coefficient of variation, hazard ratio 1.59; 95% confidence interval 1.05–2.40; P=0.03).