Angiotensin Receptor Blockers Versus Calcium Channel Blockers for First‐Line Antihypertensive Therapy and Survival in Adults Aged 75 Years or Older.
Background: Evidence guiding first‐line antihypertensive drug choice in adults aged 75 years or older is limited, despite widespread use of angiotensin receptor blockers (ARBs) and calcium channel blockers (CCBs) in late older age. Methods: We conducted a target trial emulation using a new‐user desi...
| Publicado en: | Journal of the American Geriatrics Society Vol. 74; no. 7; pp. 1938 - 1950 |
|---|---|
| Autores principales: | , , , , , , |
| Formato: | Artículo |
| Publicado: |
Wiley-Blackwell
Jul2026
|
| Materias: | |
| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ssf&AN=195715283&site=ehost-live header: @attributes: shortDbName: ssf uiTerm: 195715283 longDbName: Social Sciences Full Text (H.W. Wilson) uiTag: AN controlInfo: bkinfo: jinfo: jid: 00028614 20Q jtl: Journal of the American Geriatrics Society issn: 00028614 maglogo: Y pubinfo: dt: Jul2026 vid: 74 iid: 7 pid: 480 pub: Wiley-Blackwell artinfo: ui: 195715283 10.1111/jgs.70463 ppf: 1938 ppct: 12 formats: tig: atl: Angiotensin Receptor Blockers Versus Calcium Channel Blockers for First‐Line Antihypertensive Therapy and Survival in Adults Aged 75 Years or Older. aug: au: Noma, Hisashi Sunada, Hiroshi Sugimoto, Taiki Sada, Ken‐Ei Oda, Futoshi Maeda, Megumi Fukuda, Haruhisa affil: Department of Interdisciplinary Statistical Mathematics, The Institute of Statistical Mathematics, Tokyo, Japan The Graduate Institute for Advanced Studies, the Graduate University for Advanced Studies (SOKENDAI), Tokyo, Japan Advanced Medicine, Innovation and Clinical Research Center, Tottori University Hospital, Tottori, Japan Department of Prevention and Care Science, Research Institute, National Center for Geriatrics and Gerontology, Aichi, Japan Department of Clinical Epidemiology, Kochi Medical School, Kochi, Japan Department of Health Care Administration and Management, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan su: Hypertension Hospital care Retrospective studies Drug efficacy Old age Risk assessment Myocardial infarction Cardiovascular diseases Research funding Scientific observation Logistic regression analysis Calcium antagonists Descriptive statistics Heart failure Angiotensin receptors Medical records Acquisition of data Confidence intervals Proportional hazards models sug: subj: Hypertension Hospital care Retrospective studies Drug efficacy Old age Risk assessment Myocardial infarction Cardiovascular diseases Research funding Scientific observation Logistic regression analysis Calcium antagonists Descriptive statistics Heart failure Angiotensin receptors Medical records Acquisition of data Confidence intervals Proportional hazards models keyword: antihypertensive therapy heart failure mortality older adults target trial emulation antihypertensive therapy heart failure mortality older adults target trial emulation ab: Background: Evidence guiding first‐line antihypertensive drug choice in adults aged 75 years or older is limited, despite widespread use of angiotensin receptor blockers (ARBs) and calcium channel blockers (CCBs) in late older age. Methods: We conducted a target trial emulation using a new‐user design in a nationwide linked healthcare claims database in Japan. Adults aged ≥ 75 years who had no prescription of either drug class in the preceding 12 months and initiated an ARB (n = 10,037) or a CCB (n = 19,785) were followed from treatment initiation. The primary outcome was all‐cause mortality; secondary outcomes included hospitalization for heart failure, myocardial infarction, stroke, and major adverse cardiovascular events (MACE). Intention‐to‐treat effects were estimated using inverse probability of treatment and censoring weighting with pooled logistic regression models. Results: Among 29,822 patients, median follow‐up was 4.0 years. During follow‐up, 3487 deaths occurred. ARB therapy was associated with lower all‐cause mortality than CCB therapy (hazard ratio [HR], 0.885; 95% CI, 0.823–0.951). The estimated 5‐year risk of death was 12.7% for ARB users and 14.8% for CCB users (absolute risk difference, −2.1 percentage points; 95% CI, −3.1 to −1.0). ARB therapy was also associated with lower risks of heart failure hospitalization (HR, 0.843; 95% CI, 0.774–0.918), myocardial infarction (HR, 0.867; 95% CI, 0.795–0.945), stroke (HR, 0.931; 95% CI, 0.869–0.998), and MACE (HR, 0.889; 95% CI, 0.848–0.931). Associations were consistent across age subgroups, including adults aged ≥ 85 years. Conclusion: In adults aged 75 years or older, ARB‐based antihypertensive therapy was associated with lower risks of mortality and cardiovascular events compared with CCB‐based therapy. These findings suggest that first‐line antihypertensive drug choice may have prognostic implications in late older age. Summary: Key points ○In this nationwide target trial emulation of 29,822 adults aged 75 years or older, angiotensin receptor blocker (ARB)‐based therapy was associated with lower all‐cause mortality compared with calcium channel blocker (CCB)‐based therapy (HR 0.885; 5‐year absolute risk difference −2.1 percentage points).○ARB therapy was also associated with lower risks of heart failure hospitalization, myocardial infarction, and major adverse cardiovascular events, with consistent associations among adults aged 85 years or older.○Achieved systolic and diastolic blood pressure levels were similar between treatment strategies, suggesting that differences in outcomes may not be explained solely by blood pressure control.Why does this paper matter? ○Adults aged 75 years or older are frequently underrepresented in randomized trials of antihypertensive therapy, and ARBs and CCBs are often considered interchangeable first‐line options in routine practice. In this large nationwide study, ARB‐based therapy was associated with modest but clinically meaningful reductions in mortality and heart failure compared with CCB‐based therapy. These findings suggest that antihypertensive drug choice in late older age may have prognostic implications beyond blood pressure lowering and may inform individualized prescribing decisions in geriatric care. pubtype: Academic Journal doctype: Article src: R language: English refInfo: copyright: @attributes: flag: N holdings: @attributes: islocal: N |
|---|