Callisaya Michele L, Sharman James E, Close Jacqueline, Lord Stephen R, Srikanth Velandai K
Stroke and Ageing Research Group, Department of Medicine, Southern Clinical School, Monash University, Clayton, Victoria, Australia; Menzies Research Institute Tasmania, University of Tasmania, Hobart, Tasmania, Australia.
J Am Geriatr Soc. 2014 Aug;62(8):1527-33. doi: 10.1111/jgs.12925. Epub 2014 Jun 16.
To determine whether there is a relationship between daily defined dose (DDD) of antihypertensive drugs and the risk of falls.
Prospective population-based cohort study.
Tasmanian Study of Cognition and Gait, Australia.
Participants aged 60 to 86 randomly selected from the electoral roll.
Antihypertensive dose was quantified by estimating DDD, allowing standardized comparison of dosage between drug classes. Falls were identified prospectively over 12 months. The relative risk (RR) of falls associated with DDD was estimated using log binomial regression adjusting for age, sex, body mass index, education, cardiovascular history, and other risk factors for falls.
Participants (N=409) had a mean age of 72.0±6.9, and 56% were male. Mean baseline blood pressure was 142/80 mmHg, and 54% were taking antihypertensive medications. One hundred sixty-one participants (39%) fell over the 12 months. Those who fell were on a higher DDD of antihypertensives (1.51±2.16 than those who did not (1.03±1.42) (P=.007). Higher DDD was independently associated with greater fall risk (RR=1.07, 95% confidence interval (CI)=1.02-1.11; P=.004), with a 48% greater risk in those with a DDD of more than 3 (RR=1.48, 95% CI=1.06-2.08; P=.02), particularly in those with a history of stroke (P for interaction .01). This effect remained even after excluding those not taking antihypertensives or stratifying according to presence of hypertension and medication use.
Higher dose of antihypertensive medication is independently associated with falls in older people, particularly in those with a history of previous stroke, and with more than three standard units conferring the highest risk.
确定抗高血压药物的每日限定剂量（DDD）与跌倒风险之间是否存在关联。
基于人群的前瞻性队列研究。
澳大利亚塔斯马尼亚认知与步态研究。
从选民名单中随机选取的60至86岁参与者。
通过估算DDD对抗高血压药物剂量进行量化，以便对不同药物类别之间的剂量进行标准化比较。前瞻性地确定12个月内的跌倒情况。使用对数二项回归对年龄、性别、体重指数、教育程度、心血管病史和其他跌倒风险因素进行调整，估算与DDD相关的跌倒相对风险（RR）。
参与者（N = 409）的平均年龄为72.0±6.9岁，56%为男性。平均基线血压为142/80 mmHg，54%的人正在服用抗高血压药物。161名参与者（39%）在12个月内跌倒。跌倒者的抗高血压药物DDD（1.51±2.16）高于未跌倒者（1.03±1.42）（P = 0.007）。较高的DDD与更大的跌倒风险独立相关（RR = 1.07，95%置信区间（CI）= 1.02 - 1.11；P = 0.004），DDD超过3的人风险高48%（RR = 1.48，95% CI = 1.06 - 2.08；P = 0.02），特别是有中风病史的人（交互作用P = 0.01）。即使排除未服用抗高血压药物的人或根据高血压和药物使用情况进行分层后，这种效应仍然存在。
较高剂量的抗高血压药物与老年人跌倒独立相关，特别是有中风病史的人，且超过三个标准单位的剂量风险最高。
