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J Hypertens. 2019 Sep 19. doi: 10.1097/HJH.0000000000002245. [Epub ahead of print]

Antihypertensive drug classes and the risk of hip fracture: results from the Swedish primary care cardiovascular database.

Author information

1
Department of Molecular and Clinical Medicine, Institute of Medicine.
2
Institute of Medicine, Section of Occupational and Environmental Medicine.
3
Institute of Medicine, Department of Public Health and Community Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg.
4
R&D Centre Primary Care, Skaraborg, Skövde.
5
Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital, Division of Cardiovascular Medicine, Stockholm.
6
Centre for Bone Research at the Sahlgrenska Academy, Department of Internal Medicine and Geriatrics, University of Gothenburg, Gothenburg.
7
Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Centre for Family Medicine, Stockholm, Sweden.

Abstract

OBJECTIVE:

Hypertension and fractures related to osteoporosis are major public health problems that often coexist. This study examined the associations between exposure to different antihypertensive drug classes and the risk of hip fracture in hypertensive patients.

METHOD:

We included 59 246 individuals, 50 years and older, diagnosed with hypertension during 2001-2008 in the Swedish Primary Care Cardiovascular Database. Patients were followed from 1 January 2006 (or the date of diagnosis of hypertension) until they had their first hip fracture, died, or reached the end of the study on 31 December 2012. Cox proportional hazards models were used to calculate the risk of hip fracture across types of antihypertensive medications, adjusted for age, sex, comorbidity, medications, and socioeconomic factors.

RESULTS:

In total, 2593 hip fractures occurred. Compared to nonusers, current use of bendroflumethiazide or hydrochlorothiazide was associated with a reduced risk of hip fracture (hazard ratio 0.86; 95% CI 0.75-0.98 and hazard ratio 0.84; 95% CI 0.74-0.96, respectively), as was use of fixed drug combinations containing a thiazide (hazard ratio 0.69; 95% CI 0.57-0.83). Current use of loop diuretics was associated with an increased risk of hip fracture (hazard ratio 1.23; 95% CI 1.11-1.35). No significant associations were found between the risk of hip fracture and current exposure to beta-blockers, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, aldosterone-receptor blockers or calcium channel blockers.

CONCLUSION:

In this large observational study of hypertensive patients, the risk of hip fracture differed across users of different antihypertensive drugs, results that could have practical implications when choosing antihypertensive drug therapy.

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