Tinetti Mary E, Han Ling, McAvay Gail J, Lee David S H, Peduzzi Peter, Dodson John A, Gross Cary P, Zhou Bingqing, Lin Haiqun
Department of Medicine, Yale School of Medicine, New Haven, Connecticut, United States of America; Yale School of Public Health, New Haven, Connecticut, United States of America.
Department of Medicine, Yale School of Medicine, New Haven, Connecticut, United States of America.
PLoS One. 2014 Mar 10;9(3):e90733. doi: 10.1371/journal.pone.0090733. eCollection 2014.
Randomized trials of anti-hypertensive treatment demonstrating reduced risk of cardiovascular events in older adults included participants with less comorbidity than clinical populations. Whether these results generalize to all older adults, most of whom have multiple chronic conditions, is uncertain.
To determine the association between anti-hypertensive medications and CV events and mortality in a nationally representative population of older adults.
Competing risk analysis with propensity score adjustment and matching in the Medicare Current Beneficiary Survey cohort over three-year follow-up through 2010.
4,961 community-living participants with hypertension.
Anti-hypertensive medication intensity, based on standardized daily dose for each anti-hypertensive medication class participants used.
Cardiovascular events (myocardial infarction, unstable angina, cardiac revascularization, stroke, and hospitalizations for heart failure) and mortality.
Of 4,961 participants, 14.1% received no anti-hypertensives; 54.6% received moderate, and 31.3% received high, anti-hypertensive intensity. During follow-up, 1,247 participants (25.1%) experienced cardiovascular events; 837 participants (16.9%) died. Of deaths, 430 (51.4%) occurred in participants who experienced cardiovascular events during follow-up. In the propensity score adjusted cohort, after adjusting for propensity score and other covariates, neither moderate (adjusted hazard ratio, 1.08 [95% CI, 0.89-1.32]) nor high (1.16 [0.94-1.43]) anti-hypertensive intensity was associated with experiencing cardiovascular events. The hazard ratio for death among all participants was 0.79 [0.65-0.97] in the moderate, and 0.72 [0.58-0.91] in the high intensity groups compared with those receiving no anti-hypertensives. Among participants who experienced cardiovascular events, the hazard ratio for death was 0.65 [0.48-0.87] and 0.58 [0.42-0.80] in the moderate and high intensity groups, respectively. Results were similar in the propensity score-matched subcohort.
In this nationally representative cohort of older adults, anti-hypertensive treatment was associated with reduced mortality but not cardiovascular events. Whether RCT results generalize to older adults with multiple chronic conditions remains uncertain.
抗高血压治疗的随机试验表明，老年人心血管事件风险降低，但其纳入的参与者合并症比临床人群少。这些结果是否适用于所有老年人（其中大多数患有多种慢性病）尚不确定。
确定在全国具有代表性的老年人群中，抗高血压药物与心血管事件及死亡率之间的关联。
在医疗保险当前受益人群队列中进行竞争风险分析，并通过倾向得分调整和匹配，对截至2010年的三年随访数据进行分析。
4961名患有高血压的社区居住参与者。
根据参与者使用的每种抗高血压药物类别标准化每日剂量计算的抗高血压药物强度。
心血管事件（心肌梗死、不稳定型心绞痛、心脏血运重建、中风和因心力衰竭住院）和死亡率。
在4961名参与者中，14.1%未接受抗高血压治疗；54.6%接受中等强度治疗，31.3%接受高强度治疗。随访期间，1247名参与者（25.1%）发生心血管事件；837名参与者（16.9%）死亡。在死亡者中，430名（51.4%）发生在随访期间发生心血管事件的参与者中。在倾向得分调整队列中，在调整倾向得分和其他协变量后，中等强度（调整后的风险比，1.08[95%CI，0.89 - 1.32]）和高强度（1.16[0.94 - 1.43]）抗高血压治疗强度均与发生心血管事件无关。与未接受抗高血压治疗者相比，中等强度组所有参与者的死亡风险比为0.79[0.65 - 0.97]，高强度组为0.72[0.58 - 0.91]。在发生心血管事件的参与者中，中等强度组和高强度组的死亡风险比分别为0.65[0.48 - 0.87]和0.58[0.42 - 0.80]。在倾向得分匹配亚组中结果相似。
在这个全国具有代表性的老年人群队列中，抗高血压治疗与死亡率降低相关，但与心血管事件无关。随机对照试验结果是否适用于患有多种慢性病的老年人仍不确定。
