Greater Daily Defined Dose of Antihypertensive Medication Increases the Risk of Falls in Older People-A Population-Based Study
Greater Daily Defined Dose of Antihypertensive Medication Increases the Risk of Falls in Older People-A Population-Based Study
复制标题
DOI：
10.1111/jgs.12925
复制
发表时间：
2014-08-01
影响因子：
6.3
通讯作者：
Srikanth, Velandai K.
中科院分区：
文献类型：
--
作者：
Callisaya, Michele L.;Sharman, James E.;Srikanth, Velandai K.
目的：确定抗高血压药物的每日限定剂量（DDD）与福尔斯风险之间是否存在关系。设计：前瞻性人群队列研究。设置：澳大利亚塔斯马尼亚认知和步态研究。参与者：从选民名册中随机选择60至86岁的参与者。测量：通过估计DDD量化抗高血压药物剂量，允许药物类别之间剂量的标准化比较。在12个月内前瞻性地确定了福尔斯。采用对数二项回归法对与DDD相关的福尔斯的相对危险度（RR）进行估计，调整了年龄、性别、体重指数、教育程度、心血管病史和其他福尔斯的危险因素。结果：参与者（N = 409）的平均年龄为72.0 ± 6.9岁，56%为男性。平均基线血压为142/80 mmHg，54%正在服用降压药物。161名参与者（39%）在12个月内下降。跌倒者的抗高血压药物的DDD（1.51 +/- 2.16）高于未跌倒者（1.03 +/- 1.42）（P = .007）。DDD越高，跌倒风险越大（RR = 1.07，95%置信区间（CI）= 1.02-1.11; P = 0.004），DDD大于3的患者风险高48%（RR = 1.48，95% CI = 1.06-2.08; P = 0.02），尤其是在有卒中史的患者中（P = 0.01）。即使排除那些不服用抗高血压药物或分层根据存在的高血压和药物use.CONCLUSION：高剂量的抗高血压药物是独立相关的福尔斯在老年人，特别是在那些有中风史，并与三个以上的标准单位赋予最高的风险。
OBJECTIVES: To determine whether there is a relationship between daily defined dose (DDD) of antihypertensive drugs and the risk of falls.DESIGN: Prospective population-based cohort study.SETTING: Tasmanian Study of Cognition and Gait, Australia.PARTICIPANTS: Participants aged 60 to 86 randomly selected from the electoral roll.MEASUREMENTS: Antihypertensive dose was quantified by estimating DDD, allowing standardized comparison of dosage between drug classes. Falls were identified prospectively over 12 months. The relative risk (RR) of falls associated with DDD was estimated using log binomial regression adjusting for age, sex, body mass index, education, cardiovascular history, and other risk factors for falls.RESULTS: Participants (N = 409) had a mean age of 72.0 +/- 6.9, and 56% were male. Mean baseline blood pressure was 142/80 mmHg, and 54% were taking antihypertensive medications. One hundred sixty-one participants (39%) fell over the 12 months. Those who fell were on a higher DDD of antihypertensives (1.51 +/- 2.16 than those who did not (1.03 +/- 1.42) (P = .007). Higher DDD was independently associated with greater fall risk (RR = 1.07, 95% confidence interval (CI) = 1.02-1.11; P = .004), with a 48% greater risk in those with a DDD of more than 3 (RR = 1.48, 95% CI = 1.06-2.08; P = .02), particularly in those with a history of stroke (P for interaction .01). This effect remained even after excluding those not taking antihypertensives or stratifying according to presence of hypertension and medication use.CONCLUSION: Higher dose of antihypertensive medication is independently associated with falls in older people, particularly in those with a history of previous stroke, and with more than three standard units conferring the highest risk.