Clinical studies
Beta-blockers as single-agent therapy for hypertension and the risk of mortality among patients with chronic obstructive pulmonary disease

https://doi.org/10.1016/j.amjmed.2004.07.043Get rights and content

Purpose

To assess the association between the type of antihypertensive medication and all-cause mortality among patients with chronic obstructive pulmonary disease (COPD).

Methods

The cohort comprised 1966 patients (mean [± SD] age, 65.8 ± 10.7 years) enrolled in general internal medicine clinics at seven Veterans Affairs medical centers between December 1996 and October 1999. Patients had a diagnosis of both COPD and hypertension and were receiving single-agent antihypertensive therapy.

Results

Compared with calcium channel blockers, beta-blockers were associated with a decrease in mortality from any cause after adjusting for propensity for having been prescribed a beta-blocker (hazard ratio = 0.57; 95% confidence interval: 0.33 to 0.89). The association was similar when beta-blockers were compared with all other antihypertensive medications, and the decreased risk of mortality was apparent among patients with pre-existing cardiac disease. Restriction of analyses to long-acting calcium channel blockers or to patients who used beta-agonists did not affect the point estimates. Exposure to the remaining classes of antihypertensive agents was not associated with mortality.

Conclusion

Beta-blockers may have beneficial effects in patients who have COPD, pre-existing cardiac disease, and hypertension. Beta-blockers may not be contraindicated among patients with COPD.

Section snippets

Design and setting

We performed a cohort study using data from the Veterans Affairs (VA)-funded Ambulatory Care Quality Improvement Project (ACQUIP) (11), a randomized trial that tested whether monitoring patients’ self-reported health and providing regular reports to primary care clinicians improved clinical outcomes and patient satisfaction. ACQUIP sought to enroll all patients actively participating in the general internal medicine clinics of seven VA medical centers: Puget Sound Health Care System,

Results

We identified 1966 COPD patients with hypertension (2.5% were women) who had also been treated with a drug from a single antihypertensive medication class. Compared with patients receiving calcium channel blockers (Table 1), those taking beta-blockers were similar with regard to Seattle Index of Comorbidity scores and prevalence of chronic heart failure or diabetes, but were more likely to have cardiac disease (P = 0.02) or a previous diagnosis of acute coronary syndrome (P <0.001). Similar

Discussion

We found that among COPD patients with hypertension, beta-blockers were associated with a reduction in all-cause mortality. The risk reduction appeared similar, although not consistently statistically significant, when an alternative reference group of all other antihypertensive agents was chosen. Because of the high prevalence of ischemic heart disease among these patients, we hypothesize that the apparent benefit of beta-blockers may be related to a reduction in adverse cardiovascular events.

References (19)

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This study was supported by grants (IIR 99–376, RCD 00–018) from the Department of Veterans Affairs, Health Services Research and Development. Dr. Au is funded by a VA Health Services Research and Development Career Development Award. The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs.

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