Short-acting nifedipine and risk of stroke in elderly hypertensive patients

Neurology. 2011 Sep 27;77(13):1229-34. doi: 10.1212/WNL.0b013e318230201a. Epub 2011 Aug 17.


Objectives: Short-acting nifedipine is frequently prescribed in elderly hypertensive patients, despite warnings of possible harmful cardiovascular effects. We conducted a case-crossover study to estimate the risk of stroke episodes associated with use of short-acting nifedipine in elderly hypertensive patients.

Methods: We used the Korea Health Insurance Review & Assessment Service database. Cases included elderly hypertensive patients with hospitalization or emergency department visits for first stroke (International Classification of Diseases-10, I60-I64) between July 1, 2005, and June 30, 2006. Patients with prior stroke-related hospital admission or any visit related to TIA were excluded. Exposure to a short-acting nifedipine formulation was assessed within 7 days before the incident stroke episode (case period) and within a 7-day period preceding 60 days before the episode (control period). Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated by conditional logistic regression, with adjusting for antihypertensives, anticoagulants, antiplatelet agents, and pneumonia.

Results: A total of 16,069 stroke patients with a mean (±SD) age of 68.3 (±2.1) years were studied, of whom 8,573 (53.3%) were female. Short-acting nifedipine was prescribed at least once to 301 (1.9%) patients during the case period. An increased risk of stroke associated with use of short-acting nifedipine within 7 days (adjusted OR 2.56; 95% CI 1.96-3.37) was observed. Patients who were newly prescribed nifedipine within the recent 7 days showed an OR of 4.17 (95% CI 2.93-5.93) compared with nonusers.

Conclusion: Use of short-acting nifedipine was associated with increased risk of stroke occurrence in elderly hypertensive patients.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Confidence Intervals
  • Cross-Over Studies
  • Female
  • Hospitalization / statistics & numerical data
  • Humans
  • Male
  • National Health Programs / statistics & numerical data
  • Nifedipine / therapeutic use*
  • Odds Ratio
  • Republic of Korea / epidemiology
  • Retrospective Studies
  • Risk Factors
  • Stroke / drug therapy*
  • Stroke / epidemiology*
  • Time Factors
  • Vasodilator Agents / therapeutic use*


  • Vasodilator Agents
  • Nifedipine