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Risk of acute myocardial infarction after discontinuation of antihypertensive agents: a case–control study

Journal of Human Hypertension volume 31, pages 537–544 (2017)Cite this article

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Abstract

We performed a nested case–control study in a cohort of antihypertensive drug users to assess the association between discontinuation of different antihypertensive agents and the risk of acute myocardial infarction (AMI). Cases and controls were drawn from the Utrecht Cardiovascular Pharmacogenetics database. Patients who were hospitalised for their first AMI were considered cases and controls were not hospitalised for AMI. Antihypertensive users were defined as current users if the index date (date of AMI) fell within the prescribed duration or as discontinuers if this date fell outside the prescribed duration. According to the recency of discontinuation, discontinuers were divided into the following: recent discontinuers (⩽90 days), intermediate-term discontinuers (91–180 days) and long-term discontinuers (>180 days). We found that the risk of AMI was significantly increased in discontinuers, regardless of time since discontinuation, of beta-blockers (adjusted odds ratio (OR) 1.54; 95% confidence interval (CI; 1.25–1.91), P-value<0.0005), calcium channel blockers (CCBs; adjusted OR 2.25; 95% CI (1.53–3.30), P-value<0.0005) and diuretics (adjusted OR 1.76; 95% CI (1.24–2.48), P-value=0.002) compared to current users of these drugs. Moreover, the risk of AMI was significantly increased in long-term discontinuers (beta-blockers, CCBs, angiotensin-converting enzyme inhibitors and diuretics) and intermediate-term discontinuers (beta-blockers and CCBs) versus current users of these drugs. There was no difference in AMI risk between recent discontinuers of antihypertensive drugs versus current users of these drugs. In conclusion, discontinuation of antihypertensive drugs increases the risk of AMI after >90 days of discontinuation. This further underlines the importance of persistence to antihypertensive drug therapy to reduce the risk of AMI in patients with hypertension.

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Authors and Affiliations

  1. Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands

    F F Alharbi, P C Souverein, A H Maitland-van der Zee, A de Boer & O H Klungel

  2. Department of Clinical Chemistry and Haematology, Division of Laboratory and Pharmacy, University Medical Center Utrecht, Utrecht, The Netherlands

    M C de Groot

  3. Department of Respiratory Disease, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands

    A H Maitland-van der Zee

  4. Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands

    O H Klungel

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  1. F F Alharbi
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  2. P C Souverein
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  3. M C de Groot
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  4. A H Maitland-van der Zee
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  5. A de Boer
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  6. O H Klungel
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Correspondence to O H Klungel.

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Competing interests

OHK and MCdG had received unrestricted funding for pharmacoepidemiological research from the Dutch private-public funded Top Institute Pharma (TI Pharma Grant T6.101 Mondriaan) until 2012 and from the PROTECT project that has received support from the Innovative Medicine Initiative Joint Undertaking (www.imi.europa.eu) under grant agreement no 115004, resources of which are composed of financial contribution from the European Union’s Seventh Framework Programme (FP7/2007–2013) and EFPIA companies’ in kind contribution. In the context of the IMI Joint Undertaking, the Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, also received a direct financial contribution from Pfizer. The remaining authors declare no other conflicts.

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Alharbi, F., Souverein, P., de Groot, M. et al. Risk of acute myocardial infarction after discontinuation of antihypertensive agents: a case–control study. J Hum Hypertens 31, 537–544 (2017). https://doi.org/10.1038/jhh.2017.1

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