Tulane University Health Sciences Center, New Orleans, LA, USA.
Curr Med Res Opin. 2011 Apr;27(4):799-807. doi: 10.1185/03007995.2011.555477. Epub 2011 Feb 10.
This study investigated the risk of new-onset diabetes (NOD) among hypertensive patients initiating carvedilol therapy vs other beta-blocker (BB) therapy in a clinical practice setting.
Patients aged ≥18 years with ≥1 pharmacy claim for a BB of interest (carvedilol immediate-release [IR]/controlled-release [CR], atenolol, metoprolol succinate, or metoprolol tartrate) were identified in the IMS LifeLink Health Plan Claims Database. Index date was the first chronologically occurring prescription for any BB during the enrollment period (July 1, 2000-December 31, 2007). Patients had to be continuously eligible to receive healthcare services 6 months prior to and a minimum of 3 months after index date and have ≥1 diagnostic code for hypertension (ICD-9-CM: 401.xx-405.xx) during this time frame. Patients were excluded for having a diagnosis of diabetes mellitus (ICD-9-CM: 250.xx) and/or prescription for antidiabetic therapy in the 6 months prior to and/or 3 months after index date. Eligible patients were propensity-score matched in a 1:3 ratio (carvedilol : other BBs). Mean duration of follow-up was 12.8 and 14.8 months for the carvedilol group and other BB group, respectively. Primary outcome of interest was presence and timing of NOD.
Among 3084 patients in the carvedilol group and 9252 in the other BB group, mean age was 56 years, with 54% male. NOD rate was 3.16 per 100 person-years for carvedilol patients vs 3.36 for patients in the other BB group (NS). Risk of NOD was similar between groups (HR 0.971, 95% CI: 0.78, 1.21; P = 0.792).
Findings suggest the risk of NOD among hypertensive patients is similar between carvedilol and other BB agents (i.e., atenolol, metoprolol succinate, or metoprolol tartrate).
The use of administrative claims data and relatively short follow-up period may limit the generalizability of results.
本研究旨在评估在临床实践环境中，起始使用卡维地洛治疗的高血压患者与起始使用其他β受体阻滞剂（BB）治疗的患者相比，新发糖尿病（NOD）的风险。
在 IMS LifeLink 健康计划理赔数据库中，纳入年龄≥18 岁、至少有 1 次 BB（卡维地洛速释/控释、阿替洛尔、琥珀酸美托洛尔或酒石酸美托洛尔）用药理赔记录的患者。索引日期为纳入期间（2000 年 7 月 1 日-2007 年 12 月 31 日）内首次出现任何 BB 处方的日期。在该时间段内，患者必须在索引日期前 6 个月和后 3 个月持续有资格接受医疗保健服务，且至少有 1 次高血压诊断（ICD-9-CM：401.xx-405.xx）。患有糖尿病（ICD-9-CM：250.xx）且/或在索引日期前 6 个月内和/或后 3 个月内处方抗糖尿病治疗的患者被排除在外。将卡维地洛组和其他 BB 组的合格患者按照 1:3 的比例进行倾向评分匹配。卡维地洛组和其他 BB 组的平均随访时间分别为 12.8 个月和 14.8 个月。主要观察终点为 NOD 的发生和时间。
在卡维地洛组的 3084 例患者和其他 BB 组的 9252 例患者中，平均年龄为 56 岁，54%为男性。卡维地洛组的 NOD 发生率为每 100 人年 3.16 例，其他 BB 组为 3.36 例（无统计学差异）。两组间 NOD 的风险无差异（HR 0.971，95%CI：0.78，1.21；P=0.792）。
研究结果提示，高血压患者中卡维地洛与其他 BB 药物（即阿替洛尔、琥珀酸美托洛尔或酒石酸美托洛尔）相比，NOD 的风险相似。
本研究使用了行政理赔数据，随访时间相对较短，可能会限制研究结果的普适性。
