Antihypertensive drug use and the risk of dementia in patients with diabetes mellitus
Antihypertensive drug use and the risk of dementia in patients with diabetes mellitus
复制标题
DOI：
10.1016/j.jalz.2011.05.2414
复制
发表时间：
2012-09-01
影响因子：
14
通讯作者：
Morgan, Robert O.
中科院分区：
文献类型：
--
作者：
Johnson, Michael L.;Parikh, Niraj;Morgan, Robert O.
背景：糖尿病和高血压是痴呆的独立危险因素，高血压可能增加糖尿病患者痴呆的风险。目前尚不清楚抗高血压药物是否与这些患者的痴呆风险相关。方法：采用一项回顾性研究，对患有糖尿病的退伍军人事务部受益人进行了为期2年的随访，检查了痴呆的发病率。在调整了几个潜在的混杂因素后，使用多变量Cox比例风险回归模型来估计合并症高血压和抗高血压药物对痴呆风险的独特影响。结果：共纳入377,838例患者（平均年龄75.53±6.07岁）。在对社会人口学因素、糖尿病病程、合并症和药物进行调整后，高血压与痴呆发生风险增加相关（风险比[HR] = 1.08； 95%可信区间[CI] = 1.03, 1.14）。抗高血压药物降低了风险，从血管紧张素受体阻滞剂（ARBs）的24%到-受体阻滞剂的4%不等。在对无高血压患者的分层分析中，血管紧张素转换酶抑制剂（HR = 0.81; 95% CI = 0.69, 0.94）和arb （HR = 0.55; 95% CI = 0.34, 0.88）继续显示出保护作用。结论：合并症高血压与痴呆风险增加相关，而抗高血压药物，特别是血管紧张素转换酶抑制剂和arb，与降低风险相关，即使在没有高血压的患者中也是如此。因此，这些药物可能在延缓糖尿病患者痴呆发病方面具有潜在的治疗作用。(C) 2012阿尔茨海默病协会。版权所有。
Background: Diabetes and hypertension are independent risk factors for dementia, and hypertension may increase this risk in patients with diabetes. It is unclear whether antihypertensive drugs are associated with risk of dementia in these patients.Methods: A retrospective study using a national cohort of beneficiaries of the Department of Veterans Affairs who have diabetes examined incidence of dementia over a 2-year follow-up period. Multivariate Cox proportional hazards regression model was used to estimate the unique effects of comorbid hypertension and antihypertensive medications on risk of dementia, after adjusting for several potential confounders.Results: In all, 377,838 patients were studied (mean age: 75.53 +/- 6.07 years). After adjustments were made for sociodemographic factors, duration of diabetes, comorbidity, and comedications, hypertension was associated with increased risk of developing dementia (hazard ratio [HR] = 1.08; 95% confidence interval [CI] = 1.03, 1.14). Antihypertensive medications decreased risk, ranging from 24% for angiotensin receptor blockers (ARBs) to 4% for beta-blockers. In a stratified analysis of patients without hypertension, angiotensin-converting enzyme inhibitors (HR = 0.81; 95% CI = 0.69, 0.94) and ARBs (HR = 0.55; 95% CI = 0.34, 0.88) continued to show protective effects.Conclusions: Comorbid hypertension was associated with increased risk of dementia, whereas antihypertensive medications, especially angiotensin-converting enzyme inhibitors and ARBs, were associated with reduced risk, even among patients without hypertension. Consequently, these agents may have potential therapeutic roles in delaying the onset of dementia in patients with diabetes. (C) 2012 The Alzheimer's Association. All rights reserved.