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Pharmaceutical Economics & Health Policy| Volume 20, ISSUE 1, P160-168, January 1998

Potential biases in assessing the risks of pharmacotherapy due to mismeasurement of drug exposure

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      Abstract

      We undertook this review to propose a minimum set of standards with which any evaluation of pharmacotherapy should comply, to review the evidence on which the relative risks of calcium channel blocker therapy for hypertension are based, and to evaluate published studies against these proposed standards. We selected English-language primary study reports published in peer-reviewed biomedical journals between 1995 and 1997. All the reviewed studies suffer from either possible misclassification of antihypertensive drug therapy, mismeasurement of drug exposure, or both. Given the inadequate documentation of subjects' drug therapy, resulting relative risk estimates cannot be substantiated.

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      References

        • Psaty B
        • Heckbert S
        • Koepsell T
        • et al.
        The risk of myocardial infarction associated with antihypertensive drug therapies.
        JAMA. 1995; 274: 620-625
        • Furberg C
        • Psaty B
        • Meyer J
        Nifedipine: Dose-related increase in mortality in patients with coronary heart disease.
        Circulation. 1995; 92: 1326-1331
        • Pahor M
        • Guralnik J
        • Corti M
        • et al.
        Long term survival and use of antihypertensive medications in older persons.
        J Am Geriatr Soc. 1995; 43: 1191-1197
        • Pahor M
        • Guralnik J
        • Salive M
        • et al.
        Do calcium channel blockers increase the risk of cancer?.
        Am J Hypertens. 1996; 9: 695-699
        • Pahor M
        • Guralnik J
        • Ferrucci L
        • et al.
        Calcium channel blockade and incidence of cancer in aged populations.
        Lancet. 1996; 348: 493-497
        • Borhani N
        • Mercuri M
        • Borhani P
        • et al.
        Final outcome results of the Multi-Center Isradipine Diuretic Atherosclerosis Study (MIDAS).
        JAMA. 1996; 276: 785-791
        • Fitzpatrick A
        • Daling J
        • Furberg C
        • et al.
        Use of calcium channel blockers and breast carcinoma risk in post menopausal women.
        Am Cancer Soc. 1997; 80: 1438-1447
        • Jick H
        • Derby L
        • Gurewich V
        • Vasilakas C
        The risk of myocardial infarction associated with antihypertensive drug treatment in persons with uncomplicated essential hypertension.
        Pharmacotherapy. 1996; 16: 321-326
        • Braun S
        • Boyko V
        • Behar S
        • et al.
        Calcium antagonists and mortality in patients with coronary artery disease.
        J Am Coll Cardiol. 1996; 28: 7-11
        • Gong L
        • Zhang W
        • Zhu Y
        • et al.
        Shanghai Trial of Nifedipine in the Elderly (STONE).
        J Hypertens. 1996; 14: 1237-1245
        • Leader S
        • Mallick R
        • Briggs N
        Myocardial infarction in newly diagnosed hypertensive Medicaid patients free of coronary heart disease and treated with calcium channel blockers.
        Am J Med. 1997; 102: 150-157
        • Staessen J
        • Fagard R
        • Thijs L
        • et al.
        Randomized double-blind comparison of placebo and active treatment for older patients with isolated systolic hypertension.
        Lancet. 1997; 350: 757-762
        • Sahai H
        • Khurshid A
        Statistics in Epidemiology: Methods, Techniques, and Applications. CRC Press, Boca Raton, Fla1996: 31-47
        • Lilienfeld A
        • Lilienfeld D
        2nd ed. Foundations of Epidemiology. Oxford University Press, New York1980: 197-208
        • Leader S
        • Mallick R
        Monitoring compliance in the Pahor et al study.
        Am J Hypertens. 1996; 9: 1045-1061