Allopurinol and Cardiovascular Outcomes in Adults With Hypertension
Allopurinol and Cardiovascular Outcomes in Adults With Hypertension
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DOI：
10.1161/hypertensionaha.115.06344
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发表时间：
2016-03-01
期刊：
影响因子：
8.3
通讯作者：
Dawson, Jesse
中科院分区：
文献类型：
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作者：
MacIsaac, Rachael L.;Salatzki, Janek;Dawson, Jesse
别嘌呤醇降低青少年血压，并具有其他血管保护作用。在老年人中是否发生类似的好处仍然不清楚。我们假设别嘌醇与高血压老年人的心血管结局改善有关。使用了英国临床研究实践数据链接数据。将多元COX育种危险模型应用于中风和心脏事件（定义为心肌梗死或急性冠状动脉综合征）的估计危险比，与同尿素在10岁时使用的成年人在10岁时使用高血压> 65岁。倾向匹配的设计用于降低混淆的潜力。别嘌呤醇的暴露是一个时间依赖的变量，被定义为任何暴露，然后将其定义为高（每天300 mg）或低剂量暴露。总共研究了2032名异硫醇暴露的患者和2032名与非塞患者相匹配的患者。别嘌呤醇的使用与中风的风险（危险比，0.50; 95％置信区间，0.32-0.80）和心脏事件（危险比，0.61; 95％置信区间，0.43-0.87）的风险显着降低有关。在暴露的患者中，同尿醇（n = 1052）的高剂量治疗与中风的风险显着降低（危险比，0.58； 95％置信区间，0.36-0.94）和心脏事件（危险比，0.65; 95; 95; 95; 95; 95置信区间百分比为0.46-0.93），比低剂量治疗（n = 980）。食别嘌呤醇的使用与高血压的老年人的中风和心脏事件较低有关，尤其是在较高剂量下。需要进行前瞻性临床试验来评估别嘌醇是否改善了高血压成人的心血管结局。
Allopurinol lowers blood pressure in adolescents and has other vasoprotective effects. Whether similar benefits occur in older individuals remains unclear. We hypothesized that allopurinol is associated with improved cardiovascular outcomes in older adults with hypertension. Data from the United Kingdom Clinical Research Practice Datalink were used. Multivariate Cox-proportional hazard models were applied to estimate hazard ratios for stroke and cardiac events (defined as myocardial infarction or acute coronary syndrome) associated with allopurinol use over a 10-year period in adults aged >65 years with hypertension. A propensity-matched design was used to reduce potential for confounding. Allopurinol exposure was a time-dependent variable and was defined as any exposure and then as high (300 mg daily) or low-dose exposure. A total of 2032 allopurinol-exposed patients and 2032 matched nonexposed patients were studied. Allopurinol use was associated with a significantly lower risk of both stroke (hazard ratio, 0.50; 95% confidence interval, 0.32-0.80) and cardiac events (hazard ratio, 0.61; 95% confidence interval, 0.43-0.87) than nonexposed control patients. In exposed patients, high-dose treatment with allopurinol (n=1052) was associated with a significantly lower risk of both stroke (hazard ratio, 0.58; 95% confidence interval, 0.36-0.94) and cardiac events (hazard ratio, 0.65; 95% confidence interval, 0.46-0.93) than low-dose treatment (n=980). Allopurinol use is associated with lower rates of stroke and cardiac events in older adults with hypertension, particularly at higher doses. Prospective clinical trials are needed to evaluate whether allopurinol improves cardiovascular outcomes in adults with hypertension.