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Association between antihypertensive medication use and non-cardiovascular outcomes in older men.

Agostini JV, Tinetti ME, Han L, Peduzzi P, Foody JM, Concato J

Clinical Epidemiology Research Center 151B, VA Connecticut Healthcare System, 950 Campbell Avenue, West Haven, CT, USA. joseph.agostini@yale.edu

BACKGROUND: Antihypertensive drugs are prescribed commonly in older adults for their beneficial cardiovascular and cerebrovascular effects, but few studies have assessed antihypertensive drugs' adverse effects on non-cardiovascular outcomes in routine clinical practice. OBJECTIVE: To evaluate, among older adults, the association between antihypertensive medication use and physical performance, cognition, and mood. DESIGN AND SETTING: Prospective cohort study in a Veterans Affairs primary care clinic, with patients enrolled in 2000-2001 and assessed for medication use, comorbidities, health behaviors, and other characteristics; and followed-up 1 year later. PARTICIPANTS: 544 community-dwelling hypertensive men over age 65 years. MEASUREMENTS: Timed chair stands; Trail Making Test part B; and Centers for Epidemiologic Studies Depression (CES-D) scores. RESULTS: Participants had a mean age of 74.4 +/- 5.2 years and took a mean of 2.3 +/- 1.2 antihypertensive medications at baseline. After adjustment for age, comorbidities, level of blood pressure, and other confounders, each 1-unit increase in antihypertensive medication "intensity" was associated with a 0.11-second (95% confidence interval, 0.05-0.16) increase in the time required to complete the timed chair stands. No significant relationship was found between antihypertensive medication intensity and outcomes for Trail Making B or CES-D scores. CONCLUSIONS: A higher cumulative exposure to antihypertensive medications in community-living older men was associated with adverse effects on physical performance, but not on the cognitive or depression measures available in this study. Clinicians should consider non-cardiovascular related adverse effects when treating older males taking multiple antihypertensive medications.

Published 20 November 2007 in J Gen Intern Med, 22(12): 1661-7.
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