van der Wardt Veronika, Logan Pip, Conroy Simon, Harwood Rowan, Gladman John
Division of Rehabilitation and Ageing, School of Medicine, University of Nottingham, Nottingham, United Kingdom.
Division of Rehabilitation and Ageing, School of Medicine, University of Nottingham, Nottingham, United Kingdom.
J Am Med Dir Assoc. 2014 Sep;15(9):620-9. doi: 10.1016/j.jamda.2014.03.005. Epub 2014 Apr 20.
The range and magnitude of potential benefits and harms of antihypertensive treatment in people with dementia has not been previously established.
A scoping review to identify potential domains of benefits and harms of antihypertensive therapy in people with dementia was undertaken. Systematic reviews of these domains were undertaken to examine the magnitude of the benefits or harms.
Potential outcome domains identified in the 155 papers in the scoping review were cardiovascular events, falls, fractures and syncope, depression, orthostatic hypotension, behavioral disturbances, polypharmacy risks, kidney problems, sleep problems, interactions with cholinesterase inhibitors, and pain. The systematic reviews across these domains identified relatively few studies done in people with dementia, and no convincing evidence of safety, benefit, or harm across any of them.
Given the lack of firm evidence of benefits or harm from antihypertensive therapy in people with dementia and the weak evidence for benefits in people over 80 years of age, the current presumption that the favorable evidence drawn from the treatment of nondemented people should be extrapolated to those with dementia is contentious. There is sufficient evidence to warrant particular caution and further research into treatment in this group of patients.
此前尚未确定抗高血压治疗对痴呆症患者潜在益处和危害的范围及程度。
进行了一项范围综述，以确定抗高血压治疗对痴呆症患者潜在的益处和危害领域。对这些领域进行了系统综述，以研究益处或危害的程度。
范围综述中155篇论文确定的潜在结果领域包括心血管事件、跌倒、骨折和晕厥、抑郁、体位性低血压、行为障碍、多重用药风险、肾脏问题、睡眠问题、与胆碱酯酶抑制剂的相互作用以及疼痛。对这些领域的系统综述发现，针对痴呆症患者开展的研究相对较少，而且没有令人信服的证据表明在任何一个领域存在安全性、益处或危害。
鉴于缺乏抗高血压治疗对痴呆症患者有益或有害的确凿证据，以及对80岁以上人群有益的证据不足，目前认为从非痴呆症患者治疗中得出的有利证据应外推至痴呆症患者的假设存在争议。有足够的证据表明对此类患者的治疗需要格外谨慎并进一步研究。
