Associations of Anti-Hypertensive Treatments with Alzheimer's Disease, Vascular Dementia, and Other Dementias
Associations of Anti-Hypertensive Treatments with Alzheimer's Disease, Vascular Dementia, and Other Dementias
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DOI：
10.3233/jad-2011-110347
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发表时间：
2011-01-01
影响因子：
4
通讯作者：
Martin, Richard M.
中科院分区：
文献类型：
--
作者：
Davies, Neil M.;Kehoe, Patrick G.;Martin, Richard M.
我们研究了血管紧张素 II 受体阻滞剂 (ARB) 和血管紧张素转换酶抑制剂 (ACE-Is) 是否比其他抗高血压药物与阿尔茨海默病 (AD)、血管性痴呆 (VaD) 和其他痴呆症的相关性更强。我们在英国全科医学研究数据库中进行了嵌套病例对照分析，并前瞻性记录了抗高血压处方数据。我们对 1997 年至 2008 年间诊断的年龄 >= 60 岁的病例进行了抽样（5,797 例患有 AD，2,186 例患有 VaD，1,214 例患有未明确的/其他痴呆症），这些病例按年龄、一般实践和性别与最多 4 名对照相匹配。我们计算了 AD、血管性和未特指/其他痴呆症的比值比和剂量反应效应，将服用 ARB 或 ACE-Is 至少六个月的患者与服用其他抗高血压药物的患者进行比较。我们控制了匹配因素、合并症、吸烟状况、社会经济地位的区域测量、就诊率和血压，并通过在诊断/索引日期之前引入长达八年的时间滞后来解释反向因果关系。诊断患有 AD、血管性痴呆和未特指的/其他痴呆症的患者 ARB 和 ACE-Is 处方较少。与 ACE-Is（比值比；0.76，95% CI：0.69-0.84）相比，ARB 与 AD 的负相关性最强（比值比；0.47，95% CI：0.37-0.58）（p（差异）
We investigated whether angiotensin II receptor blockers (ARBs) and angiotensin converting enzyme inhibitors (ACE-Is) are more strongly associated with Alzheimer's disease (AD), vascular dementia (VaD), and other dementias, than other anti-hypertensive drugs. We conducted a nested case-control analysis within the UK general practice research database, with prospectively recorded anti-hypertensive prescribing data. We sampled cases aged >= 60 years and diagnosed between 1997-2008 (5,797 with AD, 2,186 with VaD, 1,214 with unspecified/other dementia) which were matched to up to four controls by age, general practice and gender. We computed odds-ratios and dose response effects for AD, vascular and unspecified/other dementia, comparing those prescribed ARBs or ACE-Is for at least six months with patients prescribed other anti-hypertensives. We controlled for matching factors, co-morbidities, smoking status, an area measure of socioeconomic status, consultation rate and blood pressure and accounted for reverse causality by introducing time-lags of up to eight years prior to diagnosis/index date. Patients diagnosed with AD, vascular and unspecified/other dementia had fewer prescriptions for ARBs and ACE-Is. Inverse associations with AD were strongest for ARBs (odds-ratio; 0.47, 95%CI: 0.37-0.58) compared with ACE-Is (odds-ratio; 0.76, 95%CI: 0.69-0.84) (p(difference)