Non-users Of Antihypertensives Research Articles

Do Patient Concerns About Antihypertensive Use For Dementia Prevention Vary By Current Use Of Antihypertensive?

PurposeAntihypertensives may have effects on the brain beyond blood pressure lowering. Ongoing clinical trials aim to evaluate the effectiveness of approved antihypertensives in preventing dementia, including patients with and without hypertension. In order for a dementia prevention strategy using antihypertensives to be effective, it is critical to understand patient concerns about this strategy in both users and non-users of antihypertensives. Thus, this study examined the association between current use of antihypertensive and having concerns about using an antihypertensive as a dementia prevention strategy, as well as sociodemographic factors associated with concerns.Patients and methodsCross-sectional, self-administered, web-based survey was conducted among 1661 patients in a large health system in January 2018. Participants reported whether they were currently taking an antihypertensive (yes/no), and what types of hypothetical concerns they have about the idea of taking an antihypertensive to prevent dementia (yes/no, for each of 7 concerns). Associations between the two variables were assessed via logistic regression, and odds ratios with 95% confidence intervals were calculated.ResultsMost respondents were female (77%), 51–70 years of age (64%), and white (89%), with 30% reporting current antihypertensive use. Compared to current users, non-users were more likely to report the five following concerns: side effects from the medication, hassle to take medications, lack of evidence, not wanting to use medications, and already having normal/low blood pressure. Non-users were also less likely to report having no concerns (adjusted OR = 0.3; 95% CI = 0.2–0.4) compared to current users. Younger age and lower income were associated with having more concerns.ConclusionPatients not currently using an antihypertensive are more likely to have concerns about using an antihypertensive for dementia prevention, compared to current antihypertensive users. Patient perspectives are important to consider for the implementation of dementia prevention strategies.

Association between demand-control model components and blood pressure in the ELSA-Brasil study: exploring heterogeneity using quantile regression analyses.

Objectives This study aimed to investigate which components of the demand-control model (DCM) are associated with blood pressure (BP) and ascertain whether these associations vary over the BP distribution. Methods We evaluated the baseline date of 11 647 current workers enrolled in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) (2008-2010), a multicenter cohort study of 35-74-year-old civil servants. Job demands, skill discretion and decision authority were measured using the Brazilian version of the Demand-Control-Support Questionnaire. The associations between DCM components and systolic and diastolic BP (SBP and DBP, respectively) were examined by gamma regression, indicated for modelling skewed continuous variables, and quantile regression. Tests were conducted for interaction with gender and use of antihypertensives. Results In the adjusted gamma models, no association was observed between DCM components and BP in the total study population. Among non-users of antihypertensives, high decision authority was marginally associated with an increase of 0.59 mmHg (95% CI 0.00-1.18) in SBP. In the quantile models, this association was found to be significant from quantiles 35-60. Further significant but inconsistent positive associations were observed between decision authority and DBP among users of antihypertensives (quantiles 5 and 10) and between skill discretion and SBP in the total study population (quantile 5). The results did not differ by gender. Conclusions Decision authority associates positively with SBP, but only in the central portion of the SBP distribution and among non-users of antihypertensives. No consistent associations were observed for skill discretion or job demands.

Blood Pressure-Related Risk Among Users Versus Nonusers of Antihypertensives: A Population-Based Cohort in Korea.

There have been few studies comparing blood pressure (BP)-related outcomes between users and nonusers of antihypertensive drugs. We constructed a population-based cohort of 492 540 Koreans aged 40 to 79 years, who had no preexisting cardiorenal diseases, from the National Health Insurance Service-Health Screening database. The primary composite outcome was death (or critical care unit admission) from cardiorenal causes, revascularization for myocardial infarction or stroke, and new-onset end-stage renal disease. Using time-dependent Cox models, we estimated hazard ratios according to BP and antihypertensive use, which were determined in each year of follow-up. Over 10 years of follow-up, the primary outcome occurred in 26 122 subjects, and 33 550 deaths were noted. Among nonusers of antihypertensives, the risk for the primary outcome increased linearly from a BP of 105/65 mm Hg, and the risk for all-cause mortality increased from a BP of 115/75 mm Hg. Among irregular users, the risk for the primary outcome increased as the BP increased >115/75 mm Hg. Among active users, the risk for the primary outcome increased in systolic BP <115 mm Hg and >135 mm Hg, and in diastolic BP <65 mm Hg and >85 mm Hg, and the risk for all-cause mortality increased in systolic BP <125 mm Hg and >135 or 145 mm Hg. In conclusion, this population-based study demonstrated that the associations between BP and adverse outcomes were J-shaped among active antihypertensive users, but linear or flat and then increasing among nonusers or irregular users.

Angiotensin‐Converting Enzyme Inhibitor Use by Older Adults Is Associated with Greater Functional Responses to Exercise

To assess the association between angiotensin converting enzyme inhibitors (ACEis) and improvements in the physical function of older adults in response to chronic exercise training. Secondary analysis of the Lifestyle Interventions and Independence for Elders Pilot (LIFE-P) study, a multisite randomized clinical trial to evaluate the effects of chronic exercise on the physical function of older adults at risk for mobility disability. Four academic research centers within the United States. Four hundred twenty-four individuals aged 70 to 89 with mild to moderate functional impairments categorized for this analysis as ACEi users, users of other antihypertensive drugs, or antihypertensive nonusers. A 12-month intervention of structured physical activity (PA) or health education promoting successful aging (SA). Change in walking speed during a 400-m test and performance on a battery of short-duration mobility tasks (Short Physical Performance Battery (SPPB)). Physical activity significantly improved the adjusted walking speed of ACEi users (P < .001) but did not of nonusers. PA improved the adjusted SPPB score of ACEi users (P < .001) and of persons who used other antihypertensive drugs (P = .005) but not of antihypertensive nonusers (P = .91).The percentage of ACEi users deriving clinically significant benefit from exercise training for walking speed (30%) and SPPB score (48%) was dramatically higher than for nonusers (14% and 12%, respectively). For older adults at risk for disability, exercise-derived improvements in physical function were greater for ACEi users than users of other antihypertensive drugs and antihypertensive nonusers.

Abstract 037: Ace Inhibitor Use by Older Adults is Associated with Improved Functional Responses to Exercise

Introduction: Functional status, assessed objectively by measures of physical performance, is a strong predictor of cardiovascular events in older adults. Angiotensin converting enzyme (ACE) inhibitors may further enhance the beneficial effects of exercise training on the functional status of older adults, but studies are lacking to confirm. The objective of this study was to assess the association of ACE inhibitor use with exercise-derived improvements in physical function among physically-limited older adults. Hypothesis: Older adults who used ACE inhibitors would have larger improvements in physical function in response to exercise than non-users. Methods: This study is a secondary analysis of the Lifestyle Interventions and Independence for Elders Pilot (LIFE-P) study. LIFE-P investigated the effects of 12-month interventions consisting of either structured physical activity or health education to promote successful aging on 424 adults aged 70-89 years at risk for becoming physically disabled. This analysis compared change in outcome measures at 6- and 12-months among participants who (1) did not use anti-hypertensive drugs, (2) used ACEi, and (3) used anti-hypertensive drugs excluding ACEi. The primary outcome measures were change in performance on a battery of short-duration mobility tasks (SPPB) and walking speed during a 400 meter test. Results: A significant medication by intervention interaction existed for SPPB (p=0.018). PA improved the adjusted SPPB score among ACEi users (p&lt;0.001) and users of other anti-hypertensive drugs (p=0.005) but not among anti-hypertensive non-users (p=0.911). Adjusted SPPB changes at 12 months were 0.95 points among ACEi users, 0.77 points among users of other anti-hypertensive drugs, and -0.08 points among anti-hypertensive non-users. For walking speed, the medication by intervention interaction was not significant (p=0.178), but a trend existed for the medication by intervention by visit interaction (p=0.094). PA significantly improved the adjusted walking speed of ACEi users (p&lt;0.001) but did not improve walking speed among the other two groups across study visits. At 12 months adjusted changes were 0.06 m/sec among ACEi users, 0.05 m/sec among anti-hypertensive non-users, and 0.02 m/sec among users of other anti-hypertensives. Conclusions: Among older adults at risk for disability, exercise-derived improvements in physical function were greatest among ACEi users. Future prospective studies are needed to confirm the true efficacy of ACE inhibitors in improving older adults’ functional responses to exercise.