抗高血压药物和老年人跌倒的相关性争议数据可能导致高血压治疗不足。因此多国学者对不同级别抗高血压药物的长期应用和不用类型跌倒的关系进行了研究,以确定不同药物剂量的效果,并评估了跌倒风险是否与脑血流量差异有关。 研究者评估了598例社区高血压人群的人口统计学、临床特征和长期应用抗高血压药物的应用情况,受试者年龄为70至97岁。然后用月历卡和电话访谈方式前瞻性随访受试者自我报告的跌倒情况。 结果显示
抗高血压药物和老年人跌倒的相关性争议数据可能导致高血压治疗不足。因此多国学者对不同级别抗高血压药物的长期应用和不用类型跌倒的关系进行了研究,以确定不同药物剂量的效果,并评估了跌倒风险是否与脑血流量差异有关。
研究者评估了598例社区高血压人群的人口统计学、临床特征和长期应用抗高血压药物的应用情况,受试者年龄为70至97岁。然后用月历卡和电话访谈方式前瞻性随访受试者自我报告的跌倒情况。
结果显示,抗高血压药物的应用与跌倒风险增加无关。与不服用以下药物的受试者相比,应用血管紧张素转换酶抑制剂(ACEI)的受试者1年有害性跌倒风险显著降低[比值比(OR)0.62],而那些应用钙离子拮抗剂(CCB)的受试者所有跌倒(OR 0.62)和室内跌倒(OR 0.57)风险均降低。使用较大剂量的上述药物与跌倒风险较低有关。
该研究表明,与不使用CCB的受试者相比,CCB使用者的脑血流量较高。大剂量抗高血压药物不增加相对健康的社区老年人跌倒风险。
参考文献:Lewis A. Lipsitz, et al. HYPERTENSIONAHA.115.05513.Published online before print May 4, 2015,doi: 10.1161/HYPERTENSIONAHA.115.05513
英文
Reexamining the Effect of Antihypertensive Medications On Falls in Old Age
Abstract
Conflicting data on the relationship between antihypertensive medications and falls in elderly people may lead to inappropriate undertreatment of hypertension in an effort to prevent falls. We aimed to clarify the relationships between the chronic use of different classes of antihypertensive medications and different types of falls, to determine the effect of medication dose, and to assess whether the risk of falls is associated with differences in cerebral blood flow.
We assessed demographics, clinical characteristics, and chronic antihypertensive medication use in 598 community-dwelling people with hypertension, aged 70 to 97 years, then followed them prospectively for self-reported falls using monthly calendar postcards and telephone interviews.
Antihypertensive medication use was not associated with an increased risk of falls. Participants reporting use of angiotensin-converting enzyme inhibitors had a significantly decreased 1-year risk of injurious falls (odds ratio, 0.62; 95% confidence interval, 0.39–0.96), whereas those using calcium channel blockers had a decreased risk of all falls (odds ratio, 0.62; 95% confidence interval, 0.42–0.91) and indoor falls (odds ratio, 0.57; 95% confidence interval, 0.36–0.91), compared with participants not taking these drugs. Larger doses of these classes were associated with a lower fall risk.
Participants taking calcium channel blockers had higher cerebral blood flow than those not taking these medications. In relatively healthy community-dwelling elderly people, high doses of antihypertensive agents are not associated with an increased risk of falls.
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