Effects of noncardiovascular comorbidities on antihypertensive use in elderly hypertensives.
Effects of noncardiovascular comorbidities on antihypertensive use in elderly hypertensives.
复制标题
非心血管合并症对老年高血压患者抗高血压药物使用的影响。
DOI：
10.1161/01.hyp.0000172753.96583.e1
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发表时间：
2005
期刊：
影响因子：
--
通讯作者：
Glynn,RobertJ
中科院分区：
文献类型：
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作者：
Wang,PhilipS;Avorn,Jerry;Brookhart,MAlan;Mogun,Helen;Schneeweiss,Sebastian;Fischer,MichaelA;Glynn,RobertJ
虽然抗高血压药物的益处已被明确确立，但在脆弱的老年人群中，它们的使用仍然不足。我们研究了非心血管合并症的存在是否会阻碍老年高血压患者使用抗高血压药物。我们在1999年和2000年期间对51,517例年龄≥65岁的宾夕法尼亚州老年人药品援助合同（PACE）项目患者进行了回顾性队列研究。所有患者均为高血压患者，并且在1999年期间进行了诊断和治疗，有资格进入以下5个相互排斥的队列之一：哮喘/慢性阻塞性肺疾病（COPD）、抑郁症、胃肠道（GI）疾病、骨关节炎或没有这4种合并症。评估2000年使用抗高血压药物的比例。采用Logistic回归分析确定4种感兴趣的合并症、社会人口学特征、其他心血管和非心血管合并症以及卫生保健利用变量对降压药使用的独立影响。在对多变量分析进行调整后，与没有这些疾病的患者相比，哮喘/慢性阻塞性肺病患者（优势比[OR]， 0.43； 95%可信区间[CI]， 0.40至0.47）、抑郁症（OR, 0.50; 95% CI， 0.45至0.55）、胃肠道疾病（OR, 0.59; 95% CI， 0.54至0.64）和骨关节炎（OR, 0.63; 95% CI， 0.59至0.67）的抗高血压药物使用始终较低。降压药使用的减少还与年龄较大、女性、白人、更严重的其他合并症、缺乏某些心血管适应症、住院、养老院护理、医生就诊和较少使用其他药物有关。高度流行的非心血管疾病似乎阻碍了老年高血压患者使用抗高血压药物。
Although the benefits of antihypertensive drugs have been clearly established, they remain underused by vulnerable older populations. We examined whether the presence of noncardiovascular comorbidity deters use of antihypertensives in elderly with hypertension. We conducted a retrospective cohort study among 51 517 patients ≥65 years of age in the Pennsylvania Pharmaceutical Assistance Contract for the Elderly (PACE) Program during 1999 and 2000. All were hypertensive and had diagnoses and used treatments during 1999 to qualify for entry into 1 of the following 5 mutually exclusive cohorts: asthma/chronic obstructive pulmonary disease (COPD), depression, gastrointestinal (GI) disorders, osteoarthritis, or none of the 4 comorbidities. Proportions using antihypertensives in 2000 were assessed. Logistic regression analysis was used to identify the independent effects on antihypertensive use of the 4 comorbidities of interest, sociodemographic characteristics, other cardiovascular and noncardiovascular comorbidity, and health care utilization variables. After adjustments in multivariable analyses, antihypertensive use was consistently lower in patients with asthma/COPD (odds ratio [OR], 0.43; 95% confidence interval [CI], 0.40 to 0.47), depression (OR, 0.50; 95% CI, 0.45 to 0.55), GI disorders (OR, 0.59; 95% CI, 0.54 to 0.64), and osteoarthritis (OR, 0.63; 95% CI, 0.59 to 0.67) relative to those without these conditions. Reduced antihypertensive use was also associated with older age, female gender, white race, more severe other comorbidities, absence of some cardiovascular indications, hospitalizations, nursing home care, physician visits, and use of fewer other medications. Highly prevalent, noncardiovascular conditions appear to deter use of antihypertensives in elderly with hypertension.