Antihypertensive medication class and pulse pressure in the elderly: analysis based on the third National Health and Nutrition Examination Survey

Abstract Background Widened pulse pressure is an independent predictor of cardiovascular outcomes in older persons. The purpose of this study was to examine the associations between antihypertensive medication class and the magnitude of pulse pressure among persons receiving treatment for hypertension in the third National Health and Nutrition Examination Survey. Methods We analyzed cross-sectional data on 1429 subjects aged 60 years or older who reported receiving one or two hypertensive drugs from the following medication classes: beta-blockers, diuretics, calcium channel blockers, or angiotensin-converting enzyme inhibitors. The sample represented about 9 million people in the noninstitutionalized U.S. population. Results For the sample as a whole, no significant pulse pressure difference was found for any medication class when compared with the referent beta-blocker group after adjustment for covariates, including mean arterial pressure. In a subgroup analysis stratified by median age, mean pulse pressure was lower in subjects older than 72 years who used diuretics alone (difference = –7 mm Hg, P<0.05) or in combination with beta-blockers (difference = –7 mm Hg, P<0.01) than in those who used beta-blockers alone. Conclusion Older hypertensive subjects who used diuretics alone or in combination with beta-blockers had lower mean pulse pressure as compared with those using beta-blockers alone. These findings lend support to recommendations for use of diuretics in older hypertensive patients.