Beta-blockers as single-agent therapy for hypertension and the risk of mortality among patients with chronic obstructive pulmonary disease

PURPOSE: To assess the association between the type of antihypertensive medication and all-cause mortality among patients with chronic obstructive pulmonary disease (COPD). METHODS: The cohort comprised 1.966 patients (mean [ +/- SD] age, 65.8 +/- 10.7 years) enrolled in general internal medicine clinics at seven Veterans Affairs medical centers between December 1996 and October 1999. Patients had a diagnosis of both COPD and hypertension and were receiving single-agent antihypertensive therapy. RESULTS: Compared with calcium channel blockers, beta-blockers were associated with a decrease in mortality from any cause after adjusting for propensity for having been prescribed a beta-blocker (hazard ratio = 0.57; 95% confidence interval: 0.33 to 0.89). The association was similar when beta-blockers were compared with all other antihypertensive medications and the decreased risk of mortality was apparent among patients with pre-existing cardiac disease. Restriction of analyses to long-acting calcium channel blockers or to patients who used beta-agonists did not affect the point estimates. Exposure to the remaining classes of antihypertensive agents was not associated with mortality. CONCLUSION: Beta-blockers may have beneficial effects in patients who have COPD, pre-existing cardiac disease, and hyper-tension. Beta-blockers may not be contraindicated among patients with COPD. (C) 2004 by Elsevier Inc.