Risk of thiazide-induced metabolic adverse events in older adults.
Risk of thiazide-induced metabolic adverse events in older adults.
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老年人发生噻嗪类代谢不良事件的风险。
DOI：
10.1111/jgs.12839
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发表时间：
2014
影响因子：
6.3
通讯作者：
Steinman,MichaelA
中科院分区：
文献类型：
--
作者：
Makam,AnilN;Boscardin,WJohn;Miao,Yinghui;Steinman,MichaelA
在真实的临床环境中，评估多病老年人噻嗪类药物引起不良事件（AE）的风险和预测因素。设计观察性队列研究。设置2007年至2008年国家退伍军人事务部数据。（N = 1，060）与倾向匹配的未使用抗高血压药物的患者相比（N = 1，060）.测量主要结果是定义为钠低于135 mEq/L，钾低于3.5 mEq/L，或估计肾小球滤过率（eGFR）较基线率降低超过25%。次要结局包括严重AE（钠<130 mEq/L，钾<3.0 mEq/L，或eGFR下降超过50%）.结果在9个月的随访中，14.3%的新噻嗪类药物使用者发生了AE，而非使用者为6.0%（需要伤害的人数（NNH）12，95%置信区间（CI）= 9-17，P< .001）; 1.8%的新使用者发生重度AE，而非使用者为0.6%（NNH = 82，P= 0.008），3.8%的新使用者因AE而急诊或住院，而非使用者为2.0%（NNH = 56，P= 0.02）。AE的风险不因年龄而异，但有5种或5种以上合并症的患者发生AE的几率是有1种合并症（高血压）的3.0倍（95% CI = 1.4-6.2）。低正常和未测量的基线钠和钾值分别是低钠血症和低钾血症的最强预测因子。只有42%的噻嗪类药物使用者在开始后90天内进行了实验室监测。在给老年人开噻嗪类处方时，应更加注意潜在的并发症，包括在开始使用噻嗪类之前和之后进行更密切的实验室监测。
ObjectivesTo evaluate the risk and predictors of thiazide‐induced adverse events (AEs) in multimorbid older adults in real‐world clinical settings.DesignObservational cohort study.SettingNational Veterans Affairs data from 2007 to 2008.ParticipantsVeterans aged 65 and older newly prescribed a thiazide (N = 1,060) compared with propensity‐matched nonusers of antihypertensive medications (N = 1,060).MeasurementsThe primary outcome was a composite of metabolic AEs defined as sodium less than 135 mEq/L, potassium less than 3.5 mEq/L, or a decrease in the estimated glomerular filtration rate (eGFR) of more than 25% from the baseline rate. Secondary outcomes included sev‐ere AEs (sodium <130 mEq/L, potassium <3.0 mEq/L, or a decrease in eGFR of more than 50%).ResultsOver 9 months of follow‐up, 14.3% of new thiazide users developed an AE, compared with 6.0% of nonusers (number needed to harm (NNH) 12, 95% confidence interval (CI) = 9–17,P< .001); 1.8% of new users developed a severe AE, compared with 0.6% of nonusers (NNH = 82,P= .008), and 3.8% of new users had an emergency department visit or hospitalization with an AE, compared with 2.0% of nonusers (NNH = 56,P= .02). Risk of AEs did not vary according to age, but having five or more comorbidities was associated with 3.0 times the odds (95% CI = 1.4–6.2) of developing an AE as having one comorbidity (hypertension). Low‐normal and unmeasured baseline sodium and potassium values were among the strongest predictors of hyponatremia and hypokalemia, respectively. Only 42% of thiazide users had laboratory monitoring within 90 days after initiation.ConclusionThiazide‐induced AEs are common in older adults. Greater attention should be paid to potential complications in prescribing thiazides to older adults, including closer laboratory monitoring before and after initiation of thiazides.