Abstract
BACKGROUND: Influenza infection may increase the risk of stroke and acute myocardial infarction (AMI). Whether influenza vaccination may reduce mortality in patients with hypertension is currently unknown. METHODS AND RESULTS: We performed a nationwide cohort study including all patients with hypertension in Denmark during 9 consecutive influenza seasons in the period 2007 to 2016 who were prescribed at least 2 different classes of antihyperten-sive medication (renin-angiotensin system inhibitors, diuretics, calcium antagonists, or beta-blockers). We excluded patients who were aged <18 years, >100 years, had ischemic heart disease, heart failure, chronic obstructive lung disease, cancer, or cerebrovascular disease. The exposure to influenza vaccination was assessed before each influenza season. The end points were defined as death from all-causes, from cardiovascular causes, or from stroke or AMI. For each influenza season, patients were followed from December 1 until April 1 the next year. We included a total of 608 452 patients. The median follow-up was 5 seasons (interquartile range, 2– 8 seasons) resulting in a total follow-up time of 975 902 person-years. Vaccine cover-age ranged from 26% to 36% during the study seasons. During follow-up 21 571 patients died of all-causes (3.5%), 12 270 patients died of cardiovascular causes (2.0%), and 3846 patients died of AMI/stroke (0.6%). After adjusting for confounders, vaccination was significantly associated with reduced risks of all-cause death (HR, 0.82; P<0.001), cardiovascular death (HR, 0.84; P<0.001), and death from AMI/stroke (HR, 0.90; P=0.017). CONCLUSIONS: Influenza vaccination was significantly associated with reduced risks of death from all-causes, cardiovascular causes, and AMI/stroke in patients with hypertension. Influenza vaccination might improve outcome in hypertension.
Original language | English (US) |
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Article number | e021715 |
Journal | Journal of the American Heart Association |
Volume | 11 |
Issue number | 6 |
DOIs | |
State | Published - Mar 15 2022 |
Bibliographical note
Funding Information:Daniel Modin was supported by the Herlev & Gentofte University Hospital Internal Research Fund and by the Novo Nordisk Foundation (grant number: NNF18OC0052966) during the preparation of this manuscript. Dr Biering-Sørensen was supported by the Fondsbørsvekselerer Henry Hansen og Hustrus Hovedlegat 2016. The sponsors had no role in the study design, data collection, data analysis, data interpretation, or writing of the article.
Publisher Copyright:
© 2022 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.
Keywords
- acute myocardial infarction
- all-cause death
- hypertension
- influenza
- influenza vaccination
- stroke
- vaccination
- Antihypertensive Agents/therapeutic use
- Influenza Vaccines/adverse effects
- Humans
- Influenza, Human/drug therapy
- Stroke/drug therapy
- Myocardial Infarction/drug therapy
- Adolescent
- Cohort Studies
- Hypertension/drug therapy
PubMed: MeSH publication types
- Research Support, Non-U.S. Gov't
- Journal Article