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Bruce M. Psaty, MD, PhD; Thomas D. Koepsell, MD, MPH; James P. LoGerfo, MD, MPH; Edward H. Wagner, MD, MPH; Thomas S. Inui, ScM, MD

JAMA. 1989;261(14):2087-2094.

Abstract
We conducted a population-based, case-control study to determine whether β-blockers, used for the treatment of hypertension, prevent first events of coronary heart disease. Cases were patients who had high blood pressure treated with medicines and who presented in 1982 to 1984 with angina or fatal or nonfatal myocardial infarction. Controls were a probability sample of health maintenance organization patients with pharmacologically treated hypertension and free of coronary heart disease. Blinded to case-control status, we reviewed the medical records of the 248 cases and 737 controls. The health maintenance organization's computerized pharmacy database was used to ascertain the use of β-blockers. Fewer cases than controls were taking β-blockers. This difference was confined to those with nonfatal infarctions. After adjustment for confounding, the estimated relative risk was 0.62 (95% confidence interval, 0.39 to 0.99). Higher doses of β-blockers conferred greater protection. We conclude that β-blockers may prevent first events of nonfatal myocardial infarction in patients with high blood pressure.

(JAMA. 1989;261:2087-2094)

Author Affiliations
From the Departments of Medicine (Drs Psaty, Lo-Gerfo, and Inui), Epidemiology (Drs Psaty and Koepsell), and Health Services (Drs Koepsell, Wagner, Lo-Gerfo, and Inui), University of Washington; and the Center for Health Studies, Group Health Cooperative of Puget Sound (Dr Wagner), Seattle, Wash.

Footnotes
The opinions, conclusions, and proposals in the text are those of the authors and do not necessarily reflect those of the agencies that provided funding for this research.

Reprint requests to Department of Medicine, ZA-60, Harborview Medical Center, 325 Ninth Ave, Seattle, WA 98104 (Dr Psaty).

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