Antihypertensives and the risk of serious hypoglycemia in older persons using insulin or sulfonylureas
Antihypertensives and the risk of serious hypoglycemia in older persons using insulin or sulfonylureas
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DOI：
10.1001/jama.278.1.40
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发表时间：
1997-07-02
影响因子：
120.7
通讯作者：
Griffin, MR
中科院分区：
文献类型：
--
作者：
Shorr, RI;Ray, WA;Griffin, MR
背景。-β-受体阻滞剂和血管紧张素转换酶（ACE）抑制剂是治疗糖尿病的有效降压药物，但β-受体阻滞剂可减弱对低血糖的自主反应，增加低血糖的风险。ACE抑制剂可能会增加胰岛素敏感性，使使用者易患低血糖症。确定使用心脏选择性β受体阻滞剂、非选择性β受体阻滞剂、ACE抑制剂、噻嗪类利尿剂、钙通道阻滞剂或其他抗高血压药物是否会改变胰岛素或磺脲类处方老年人发生严重低血糖的风险。回顾性队列研究，背景。田纳西州医疗补助计划，病人。从1985年到1989年，共有13559名老年人（平均年龄，78+/-7岁）参加了医疗补助计划，他们接受了胰岛素（n=5171，38%）或磺脲类药物（n=8368，62%）的处方，这些参加者共提供了33107人-年的胰岛素或磺脲类药物使用进行随访。低血糖症状相关的住院、急诊或死亡以及伴随的血糖测定低于2.8 mmol/L（50 mg/dL），结果。在研究期间，我们确定了598例发生严重低血糖的患者，在未使用抗高血压药物的患者中，严重低血糖的发生率为2.01/100人-年。严重低血糖的粗发生率在ACE抑制剂使用者中最高（2.47/100人-年），心脏选择性β受体阻滞剂使用者中最低（1.23/100人-年），然而，当我们控制人口统计学特征和合并症标志物时，与对照组相比，任何类别降压药使用者发生严重低血糖的风险均无统计学显著性增加或减少。不服用抗过敏药物的人使用非选择性β受体阻滞剂作为参照组，这些药物中的每一种都与低血糖风险相关，但无统计学意义。在这一人群中，特定的降压药物治疗对老年糖尿病患者低血糖风险的影响很小。应根据安全性和有效性的其他考虑因素选择治疗。
Context.-beta-Blockers and angiotensin-converting enzyme (ACE) inhibitors are effective antihypertensive agents for patients with diabetes mellitus, However, beta-blockers attenuate some components of the autonomic response to hypoglycemia and could increase the risk of hypoglycemia. ACE inhibitors may increase insulin sensitivity and predispose users to hypoglycemia.Objective.-To determine whether use of cardioselective beta-blockers, nonselective beta-blockers, ACE inhibitors, thiazide diuretics, calcium channel blockers, or other antihypertensive drugs alters the risk of developing serious hypoglycemia among older persons prescribed insulin or sulfonylureas,Design.-Retrospective cohort study,Setting.-Tennessee Medicaid Program,Patients.-A total of 13 559 elderly (mean age, 78+/-7 years) Medicaid enrollees, who were prescribed insulin (n=5171, 38%) or sulfonylureas (n=8368, 62%) from 1985 through 1989, These enrollees contributed a total of 33 107 person-years of insulin or sulfonylurea use for follow-up.Measurements.-Hospitalization, emergency department admission, or death associated with hypoglycemic symptoms and a concomitant blood glucose determination of less than 2.8 mmol/L (50 mg/dL),Results.-We identified 598 persons with an episode of serious hypoglycemia during the study period, The rate of serious hypoglycemia was 2.01 per 100 person-years among those who were not prescribed antihypertensives. Crude rates of serious hypoglycemia were highest among users of ACE inhibitors (2.47 per 100 person-years) and lowest among users of cardioselective beta-blockers (1.23 per 100 person-years), However, when we controlled for demographic characteristics and markers of comorbidity, there was no statistically significant increase or decrease in risk of serious hypoglycemia among users of any class of antihypertensive agents compared with nonusers of antihyperiensive drugs. Using nonselective beta-blockers as the reference group, each of these agents was associated with a lower, but not statistically significant, risk of hypoglycemia.Conclusions.-In this population, specific antihypertensive drug therapy had little impact an the risk of hypoglycemia in older diabetic patients. Therapy should be chosen based on other considerations of safety and effectiveness.