Beta-blockers as single-agent therapy for hypertension and the risk of mortality among patients with chronic obstructive pulmonary disease
Beta-blockers as single-agent therapy for hypertension and the risk of mortality among patients with chronic obstructive pulmonary disease
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DOI：
10.1016/j.amjmed.2004.07.043
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发表时间：
2004-12-15
影响因子：
5.9
通讯作者：
Fihn, SD
中科院分区：
文献类型：
--
作者：
Au, DH;Bryson, CL;Fihn, SD
目的：探讨慢性阻塞性肺疾病(COPD)患者降压药物种类与全因死亡率的关系。方法：队列研究对象为1996年12月至1999年10月在7个退伍军人事务医疗中心普通内科门诊就诊的1.966例患者，平均年龄65.8±10.7岁。结果：与钙通道阻滞剂相比，在调整了服用β-受体阻滞剂的倾向后，β-受体阻滞剂与任何原因导致的死亡率降低相关(危险比=0.57；95%可信区间：0.33-0.89)。当将β-受体阻滞剂与所有其他抗高血压药物进行比较时，这种关联是相似的，并且在既往存在心脏病的患者中死亡风险的降低是明显的。对长效钙通道阻滞剂或使用β-激动剂的患者的分析限制不影响点数估计。暴露于其余类别的抗高血压药物与死亡率无关。结论：β-受体阻滞剂可能对患有COPD、既有心脏病和高血压的患者有有益的影响。β-受体阻滞剂在慢性阻塞性肺疾病患者中可能不是禁忌。(C)2004年，爱思唯尔公司。
PURPOSE: To assess the association between the type of antihypertensive medication and all-cause mortality among patients with chronic obstructive pulmonary disease (COPD).METHODS: The cohort comprised 1.966 patients (mean [ +/- SD] age, 65.8 +/- 10.7 years) enrolled in general internal medicine clinics at seven Veterans Affairs medical centers between December 1996 and October 1999. Patients had a diagnosis of both COPD and hypertension and were receiving single-agent antihypertensive therapy.RESULTS: Compared with calcium channel blockers, beta-blockers were associated with a decrease in mortality from any cause after adjusting for propensity for having been prescribed a beta-blocker (hazard ratio = 0.57; 95% confidence interval: 0.33 to 0.89). The association was similar when beta-blockers were compared with all other antihypertensive medications and the decreased risk of mortality was apparent among patients with pre-existing cardiac disease. Restriction of analyses to long-acting calcium channel blockers or to patients who used beta-agonists did not affect the point estimates. Exposure to the remaining classes of antihypertensive agents was not associated with mortality.CONCLUSION: Beta-blockers may have beneficial effects in patients who have COPD, pre-existing cardiac disease, and hyper-tension. Beta-blockers may not be contraindicated among patients with COPD. (C) 2004 by Elsevier Inc.