Cardiovascular risk and blood pressure lowering treatment among elderly individuals: Evidence for Cardiovascular Prevention from Observational Cohorts in Japan.
Cardiovascular risk and blood pressure lowering treatment among elderly individuals: Evidence for Cardiovascular Prevention from Observational Cohorts in Japan.
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老年人的心血管风险和降血压治疗：来自日本观察队列的心血管预防证据。
DOI：
10.1097/hjh.0000000000001555
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发表时间：
2018
期刊：
影响因子：
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通讯作者：
Okamura T; Evidence for Cardiovascular Prevention From Observational Cohorts in Japan (EPOCH-JAPAN) Research Group.
中科院分区：
文献类型：
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作者：
Asayama K;Ohkubo T;Satoh A;Tanaka S;Higashiyama A;Murakami Y;Yamada M;Saitoh S;Okayama A;Miura K;Ueshima H;Miyamoto Y;Okamura T; Evidence for Cardiovascular Prevention From Observational Cohorts in Japan (EPOCH-JAPAN) Research Group.
目的：在接受抗高血压药物治疗的老年人中，几乎没有证据支持血压升高的风险增加。方法：为了阐明接受抗高血压药物治疗的老年人对血压水平和残余心血管风险的影响，我们分析了来自7个日本普通人群的26133名60-岁的居民的个人参与数据，并按年龄类别、60-74岁(年轻人)和75-(老年)以及基线调查(1980-1995年)的降压药使用情况进行交叉分类。结果：在中位数12.7年的随访期内，观察到2451例心血管死亡。与未接受治疗的参与者相比，接受治疗的参与者的心血管死亡率的多变量调整风险比在青年和老年参与者中分别为1.30(95%可信区间，1.16-1.46)和1.35(95%可信区间，1.16-1.56)。在不考虑降压药物的情况下，随着血压升高，青年患者心血管和卒中总死亡率的风险显著增加(P≤0.0013)，但在老年患者中并不显著(P≥0.061)。结论：尽管对血压的影响在青年患者中比在老年患者中更明显，但临床医生在给老年患者开降压药时应考虑到此类患者需要进一步监测。
Objective:There is little evidence to support an increased risk of blood pressure (BP) elevation among elderly individuals receiving antihypertensive drug treatment.Methods:To clarify the impact on BP level and residual cardiovascular risk in treated elderly individuals, we analysed individual participant data of 26 133 residents aged 60–89 years from seven Japanese general populations and cross-classified participants by age category, 60–74 (young-old) versus 75–89 years (old-old), and by usage of antihypertensive medication at baseline survey (1980–1995).Results:During a median follow-up period of 12.7 years, 2451 cardiovascular deaths were observed. Multivariable-adjusted hazard ratios of cardiovascular mortality in treated participants compared with untreated participants were 1.30 [95% confidence intervals, 1.16–1.46) and 1.35 (95% confidence interval, 1.16–1.56) in young-old and old-old participants, respectively. Irrespective of antihypertensive medication, the risk increase of total cardiovascular and stroke mortality with elevation of BP was significant among young-old (P≤ 0.0013), but not significant among old-old participants (P≥ 0.061).Conclusion:Although impact on BP was more evident among young-old than old-old individuals, clinicians who prescribe antihypertensive medication to elderly patients should consider that such patients require further monitoring.