Clinical studiesBeta-blockers as single-agent therapy for hypertension and the risk of mortality among patients with chronic obstructive pulmonary disease
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)
- et al.
Treatment of systemic hypertension in patients with pulmonary diseaseCOPD and asthma
Chest
(2003) - et al.
Effectiveness of beta-blocker therapy after acute myocardial infarction in elderly patients with chronic obstructive pulmonary disease or asthma
J Am Coll Cardiol.
(2001) - et al.
The assessment of refill compliance using pharmacy recordsmethods, validity, and applications
J Clin Epidemiol.
(1997) - et al.
A primer and comparative review of major US mortality databases
Ann Epidemiol.
(2002) - et al.
Validation of case-mix measures derived from self-reports of diagnoses and health
J Clin Epidemiol.
(2002) Effect of inhaled triamcinolone on the decline in pulmonary function in chronic obstructive pulmonary disease
N Engl J Med.
(2000)- et al.
Randomised, double blind, placebo controlled study of fluticasone propionate in patients with moderate to severe chronic obstructive pulmonary diseasethe ISOLDE trial
BMJ
(2000) - et al.
Effects of smoking intervention and the use of an inhaled anticholinergic bronchodilator on the rate of decline of FEV1. The Lung Health Study
JAMA
(1994) - et al.
Long-term treatment with inhaled budesonide in persons with mild chronic obstructive pulmonary disease who continue smoking. European Respiratory Society Study on Chronic Obstructive Pulmonary Disease
N Engl J Med.
(1999)
Cited by (0)
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.