Abstract P3079: Proton Pump Inhibitor Use and Incident Hypertension in Postmenopausal Women: Results from the Women’s Health Initiative.

Introduction: Proton pump inhibitors (PPI) could impact blood pressure regulation by suppressing gastric acid required for the conversion of oral nitrite into nitric oxide. Whether PPI use is associated with incident hypertension remains unknown. Methods: We included 64,720 postmenopausal women who were free from cardiovascular disease and hypertension at enrollment into the Women’s Health Initiative Observational Study (1993-1998). Baseline PPI use and duration was ascertained from medication inventories. The outcome was physician diagnosed-treated hypertension, assessed by self-report on annual questionnaires. Kaplan-Meier curves were used to visualize unadjusted annualized incident hypertension according to baseline PPI use. Hazard ratios (HR) and 95% confidence intervals (CI) were estimated using multivariable Cox proportional hazard models for incident hypertension according to baseline PPI use (no/yes) and duration (< 1 year, 1-3 years, >3 years). Propensity score adjustment was used to account for residual confounding by indication. Results: A total of 28,951 cases of incident hypertension were accrued after a mean follow up of 8.7 years. PPI users had significantly higher annualized hypertension incidence compared to non-users over the follow-up time (Figure). PPI use was associated with 15% higher risk of hypertension compared to non-use in the fully adjusted model (HR: 1.15, 95%CI: 1.06-1.25) and the association remained significant after propensity score adjustment (HR: 1.17, 95%CI: 1.14-1.19). Longer PPI use durations were associated with higher risk of hypertension (HR: 1.11, 1.16, 1.28, respectively) and showed a significant trend (P <.001). Conclusions: PPI use was associated with higher risk of diagnosed hypertension in postmenopausal women after adjusting for relevant confounders. The association showed a significant trend according to PPI duration of use. More research is needed to confirm such results.