Effects of antihypertensive drug treatments on fracture outcomes: a meta-analysis of observational studies
Effects of antihypertensive drug treatments on fracture outcomes: a meta-analysis of observational studies
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DOI：
10.1111/j.1365-2796.2006.01695.x
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发表时间：
2006-10-01
影响因子：
11.1
通讯作者：
Takkouche, B.
中科院分区：
文献类型：
--
作者：
Wiens, M.;Etminan, M.;Takkouche, B.
目标。定量汇总与5类降压药物暴露相关的骨折风险观察性研究结果：血管紧张素转换酶（ACE）抑制剂、利尿剂（特别是噻嗪类利尿剂）、受体阻滞剂、钙通道阻滞剂和受体阻滞剂。系统回顾和荟萃分析。数据源。在MEDLINE， EMBASE和LILACS数据库中列出的出版物，ISI会议记录和检索文章的参考书目。从最早的日期到2005年12月，资料都被搜索到了。检查方法。我们纳入了病例对照和队列研究，这些研究显示了抗高血压药物暴露与骨折结局之间的相对风险和置信区间（ci）。数据被提取到标准化的计算机工作表上。研究质量采用针对病例对照或队列研究设计的10分制问卷进行评估。确认了54项研究。使用HEpiMA软件计算汇总估计。使用噻嗪类利尿剂发生骨折的总相对危险度（RR）为0.86 (95% CI 0.81-0.92)，使用非噻嗪类利尿剂发生骨折的总相对危险度（RR）为1.14 （95% CI 0.84-1.54）。使用受体阻滞剂可显著减少骨折发生率（RR 0.86, 95% CI 0.70-0.98）。一项有ACE抑制剂数据的研究显示出保护作用（RR 0.81, 95% CI 0.73-0.89）。没有发现骨折与暴露于α受体阻滞剂或钙通道阻滞剂之间有显著关联。噻嗪类利尿剂和受体阻滞剂似乎可以降低老年人骨折的风险。然而，在随机对照试验的数据确定其疗效之前，这些药物不能被推荐作为骨折的预防性治疗方法。使用这些廉价药物治疗高血压的患者也可能受益于骨折风险的降低。
Objective. To quantitatively pool findings from observational studies on the risk of fracture outcomes associated with exposure to five antihypertensive drug classes: angiotensin-converting enzyme (ACE) inhibitors, diuretics (in particular thiazide diuretics), beta-blockers, calcium-channel blockers and alpha-blockers.Design. Systematic review and meta-analysis.Data sources. Publications listed in the MEDLINE, EMBASE and LILACS databases, the ISI proceedings, and bibliographies of retrieved articles. Sources were searched from the earliest possible dates through December 2005.Review methods. We included case-control and cohort studies presenting relative risks and confidence intervals (CIs) for the association between exposure to antihypertensive agents and fracture outcomes. Data were extracted onto a standardized computer worksheet. Study quality was assessed using a 10-point questionnaire specific to case-control or cohort study design.Results. Fifty-four studies were identified. Pooled estimates were computed using the software HEpiMA. The pooled relative risk (RR) of any fracture with use of thiazide diuretics was 0.86 (95% CI 0.81-0.92) and 1.14 (95% CI 0.84-1.54) with use of nonthiazide diuretics. There was a statistically significant reduction of any fracture with use of beta-blockers, (RR 0.86, 95% CI 0.70-0.98). The one study with ACE inhibitor data showed protection (RR 0.81, 95% CI 0.73-0.89). No significant associations were found between fractures and exposure to alpha-blockers or calcium-channel blockers.Conclusions. Thiazide diuretics and beta-blockers appear to lower the risk of fractures in older adults. However, these agents cannot be recommended as preventive therapies for fractures until data from randomized controlled trials have established their efficacy. Patients who use these inexpensive drugs as treatments for hypertension may also benefit from a reduction in fracture risk.