Risk of Hospitalization for Cardiovascular Events with β-Blockers in Hypertensive Patients: A Retrospective Cohort Study.
Risk of Hospitalization for Cardiovascular Events with β-Blockers in Hypertensive Patients: A Retrospective Cohort Study.
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DOI：
10.1007/s40119-018-0117-y
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发表时间：
2018-12
影响因子：
3.4
通讯作者：
Neutel J
中科院分区：
文献类型：
--
作者：
Basile J;Egan B;Punzi H;Ali S;Li Q;Patel M;Neutel J
β-受体阻滞剂是一类异质药物，由于观察到非血管舒张性 β-受体阻滞剂会出现不利的长期心血管事件，因此不再推荐用于初始抗高血压单一治疗。然而，血管舒张性β1-选择性拮抗剂/β3激动剂奈必洛尔和非血管舒张性β1-阻滞剂阿替洛尔和美托洛尔之间的心血管事件风险比较尚不清楚。使用美国索赔数据（2007-2014 年）确定奈必洛尔、阿替洛尔或美托洛尔单药治疗使用者的高血压事件。 2008 年 1 月 1 日/之后的第一个 β 受体阻滞剂声明定义了索引药物/日期。对没有指数前心血管病史的高血压患者进行随访，直至指数药物停药（>90 天供应缺口）、使用其他 β 受体阻滞剂或连续计划入组结束。使用逻辑回归对患者进行配对倾向评分匹配，并根据基线人口统计数据、查尔森合并症指数评分、合并慢性肺病、风湿病、肾病和糖尿病以及基线期间使用其他抗高血压药物进行调整。通过 Cox 比例风险回归评估心血管事件首次住院索赔的时间，并根据上述变量进行调整。 81,402 名患者符合纳入标准（每个匹配治疗队列中 n = 27,134 例），队列间基线特征、合并症或平均随访时间没有差异。阿替洛尔和美托洛尔队列因复合事件（心肌梗塞、心绞痛、充血性心力衰竭、中风）住院的风险高于奈必洛尔使用者（调整后的风险比[95%置信区间]阿替洛尔：1.68 [1.29，2.17]；美托洛尔：2.05 [1.59，2.63]； P < 0.001，两者）。奈必洛尔治疗后大多数个体心血管事件的风险也较低，包括与阿替洛尔相比心肌梗死和心绞痛，以及与美托洛尔相比心肌梗死、充血性心力衰竭和心绞痛（P<0.05，全部）。在这项针对高血压患者使用三种不同 β1 选择性阻滞剂单药治疗的大型回顾性队列研究中，与阿替洛尔或美托洛尔相比，奈必洛尔因复合心血管事件而住院的风险显着降低。艾尔建公司，美国新泽西州麦迪逊。本文的在线版本 (10.1007/s40119-018-0117-y) 包含补充材料，可供授权用户使用。
β-Blockers are a heterogenous class of drugs that are no longer recommended for initial antihypertension monotherapy due to unfavorable long-term cardiovascular events observed with non-vasodilatory β-blockers. However, the comparative cardiovascular event risk between the vasodilatory β1-selective antagonist/β3 agonist nebivolol and non-vasodilatory β1-blockers, atenolol and metoprolol, is unknown. Incident nebivolol, atenolol, or metoprolol monotherapy users with hypertension were identified using US claims data (2007–2014). The first β-blocker claim on/after 1/1/2008 defined the index drug/date. Hypertensive patients without pre-index cardiovascular history were followed until index drug discontinuation (> 90 day supply gap), use of other β-blockers, or end of continuous plan enrollment. Patients were pair-wise propensity score-matched using logistic regression, adjusted for baseline demographics, Charlson Comorbidity Index score, comorbid chronic pulmonary disease, rheumatic disease, renal disease, and diabetes, and use of other antihypertensive drugs during baseline. Time to first hospital claim for a cardiovascular event was assessed via Cox proportional hazards regression, adjusted for the variables above. Inclusion criteria were met by 81,402 patients (n = 27,134 in each matched treatment cohort), with no between-cohort differences in baseline characteristics, comorbid conditions, or average follow-up duration. Atenolol and metoprolol cohorts had greater risk of hospitalization for a composite event (myocardial infarction, angina, congestive heart failure, stroke) than nebivolol users (adjusted hazard ratios [95% confidence interval] atenolol: 1.68 [1.29, 2.17]; metoprolol: 2.05 [1.59, 2.63]; P < 0.001, both). Risks of most individual cardiovascular events were also lower with nebivolol, including myocardial infarction and angina versus atenolol, and myocardial infarction, congestive heart failure, and angina versus metoprolol (P < 0.05, all). Nebivolol was associated with significantly lower risk of hospitalization due to composite cardiovascular events than atenolol or metoprolol in this large retrospective cohort study of monotherapy with three different β1-selective blockers in hypertensive patients. Allergan plc, Madison, NJ, USA. The online version of this article (10.1007/s40119-018-0117-y) contains supplementary material, which is available to authorized users.