Antihypertensive Medications and C-Reactive Protein in the Multi-Ethnic Study of Atherosclerosis

Background The effects of different antihypertensive medication classes on C-reactive protein (CRP) levels are still not well characterized, and might be of relevance to treatment choices. Methods We studied the association between antihypertensive medication class and CRP levels among participants with treated hypertension in the Multi-Ethnic Study of Atherosclerosis. We performed a cross-sectional study of hypertensive participants free of clinical cardiovascular disease who were taking one or more of the following medication classes: β-blockers, calcium channel blockers, diuretics, and angiotensin-converting enzyme (ACE) inhibitors, or angiotensin II type I receptor blockers (ARB). Results Among 2340 participants taking one or more antihypertensive medications, the mean serum CRP level was lower among participants taking a β-blocker than among those not taking a β-blocker (2.13 v 2.54 mg/L, P = .002). This difference persisted after multivariate adjustment (P = .021). There were no other statistically significant differences in multivariate models. Among 1314 participants receiving monotherapy, the multivariate adjusted mean CRP level among participants taking a β-blocker was lower (1.97 mg/L) than those taking a diuretic (2.72 mg/L, P< .001). In this monotherapy group, participants taking an ACE inhibitor or ARB also had a lower adjusted mean CRP (2.25 mg/L) than those taking a diuretic (P = .046). African-American race/ethnicity did not modify any of those relationships. Conclusions The β-blocker use was associated with lower CRP levels overall and among participants on monotherapy, whereas ACE inhibitor and ARB use was associated with lower CRP levels among participants on monotherapy. These findings warrant further evaluation in randomized trials.