LONG-TERM SURVIVAL AND USE OF ANTIHYPERTENSIVE MEDICATIONS IN OLDER PERSONS
LONG-TERM SURVIVAL AND USE OF ANTIHYPERTENSIVE MEDICATIONS IN OLDER PERSONS
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DOI：
10.1111/j.1532-5415.1995.tb07393.x
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发表时间：
1995-11-01
影响因子：
6.3
通讯作者：
HAVLIK, RJ
中科院分区：
文献类型：
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作者：
PAHOR, M;GURALNIK, JM;HAVLIK, RJ
目的：确定使用特定钙拮抗剂和血管紧张素转换酶抑制剂的老年高血压患者的死亡风险是否与使用β受体阻滞剂的患者不同。设计：一项从1988年持续到1992年的前瞻性队列研究。集合：老年流行病学研究已建立的人群中的三个社区。对象：年龄大于或等于71岁的高血压参与者(n=906)，他们没有充血性心力衰竭的证据，并且使用β-受体阻滞剂(n=515)、维拉帕米(n=77)、地尔硫卓(n=92)、硝苯地平(n=74)或血管紧张素转换酶抑制剂(n=148)。硝苯地平为短效药物。测量：主要观察指标为全因死亡率。年龄、性别、吸烟、高密度脂蛋白-胆固醇、血压、地高辛和利尿剂的摄入量、身体残疾、自我健康状况和合并症被视为混杂因素。结果：在3538人年的随访中，188名参与者死亡(每1000人年死亡53人)。与β受体阻滞剂相比，在调整了年龄、性别、合并疾病和其他健康相关因素后，使用维拉帕米、地尔硫卓、硝苯地平和血管紧张素转换酶抑制剂导致死亡的相对风险(95%可信区间)分别为0.8(0.4-1.4)、1.3(0.8-2.1)、1.7(1.1-2.7)和0.9(0.6-1.4)。在排除了有其他潜在的β-受体阻滞剂禁忌症的参与者以及对冠心病和利尿剂的使用进行分层后，结果没有变化。硝苯地平的剂量越大，死亡率越高。结论：与β-受体阻滞剂相比，短效硝苯地平的使用与老年高血压患者的生存率降低有关。然而，影响高危患者使用特定药物的选择性因素不能完全打折扣，最终结论将取决于临床试验。
OBJECTIVE: To determine whether older persons with hypertension who use specific calcium antagonists and ACE inhibitors have a different risk of mortality than those using beta-blockers.DESIGN: A prospective cohort study continuing from 1988 through 1992.SETTING: Three communities of the Established Populations for Epidemiologic Studies of the Elderly.PARTICIPANTS: Hypertensive participants aged greater than or equal to 71 years (n = 906) who had no evidence of congestive heart failure and who were using either beta-blockers (n = 515), verapamil (n = 77), diltiazem (n = 92), nifedipine (n = 74), or ACE inhibitors (n = 148). Nifedipine was of the short acting variety.MEASUREMENTS: The main outcome measure was all-cause mortality. Age, gender, smoking, HDL-cholesterol, blood pressure, intake of digoxin and diuretics, physical disability, self-perceived health, and comorbid conditions were examined as confounders.RESULTS: During 3538 person-years of follow-up, 188 participants died (53 deaths per 1000 person-years). Compared with beta-blockers, after adjusting for age, gender, comorbid conditions and other health-related factors, the relative risks (95% confidence interval) for mortality associated with use of verapamil, diltiazem, nifedipine, and ACE inhibitors were 0.8 (0.4-1.4), 1.3 (0.8-2.1), 1.7 (1.1-2.7), and 0.9 (0.6-1.4), respectively. The results were unchanged after excluding participants with other potential contraindications to beta-blockers and after stratifying on coronary heart disease and use of diuretics. Higher doses of nifedipine were associated with higher mortality.CONCLUSION: Compared with beta-blockers, use of short acting nifedipine was associated with decreased survival in older hypertensive persons. However, selective factors influencing the use of specific drugs in higher risk patients could not be completely discounted, and final conclusions will depend on clinical trials.