| Summary: | <br><strong>Background: </strong>Antihypertensive drugs (AHTs), especially calcium channel blockers (CCBs), have been associated with differential rates of a number of neuropsychiatric outcomes. Delirium is commonly attributed to medication, including AHTs, but delirium incidence has not been compared directly between AHT classes.</br>
<br><strong>Methods: </strong>Using a federated electronic health records network of 25.5 million people aged 50 years or older, we measured rates of delirium over a 2-year period in patients prescribed CCBs compared to the other main AHT classes. Extensive propensity score matching was used to create cohorts matched for a range of demographic factors and delirium risk factors. Negative control outcomes were also measured.</br>
<br><strong>Results: </strong>Cohort sizes ranged from 54,000 to 577,000. Delirium was more common with CCBs than with renin-angiotensin system (RAS) agents (~40% higher) but less common than with beta-blockers (~20% lower). These differences remained when patients with a range of other delirium risk factors were excluded, and they were not paralleled by the negative control outcomes. Comparisons between CCBs and diuretics produced inconclusive results.</br>
<br><strong>Conclusions: </strong>CCBs are associated with higher rates of delirium than RAS agents, but lower rates compared to beta-blockers. The findings add to the list of factors which may be considered when choosing AHT class.</br>
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