Cardiovascular Research Center, Gentofte Hospital, University of Copenhagen, Denmark.
Department of Health Research and Policy, Stanford University School of Medicine, Stanford, California.
JAMA Intern Med. 2015 Dec;175(12):1923-31. doi: 10.1001/jamainternmed.2015.5346.
Perioperative β-blocker strategies are important to reduce risks of adverse events. Effectiveness and safety may differ according to patients' baseline risk.
To determine the risk of major adverse cardiovascular events (MACEs) associated with long-term β-blocker therapy in patients with uncomplicated hypertension undergoing noncardiac surgery.
DESIGN, SETTING, AND PARTICIPANTS: Association study based on in-hospital records and out-of-hospital pharmacotherapy use using a Danish nationwide cohort of patients with uncomplicated hypertension treated with at least 2 antihypertensive drugs (β-blockers, thiazides, calcium antagonists, or renin-angiotensin system [RAS] inhibitors) undergoing noncardiac surgery between 2005 and 2011.
Various antihypertensive treatment regimens, chosen as part of usual care.
Thirty-day risk of MACEs (cardiovascular death, nonfatal ischemic stroke, nonfatal myocardial infarction) and all-cause mortality, assessed using multivariable logistic regression models and adjusted numbers needed to harm (NNH).
The baseline characteristics of the 14,644 patients who received β-blockers (65% female, mean [SD] age, 66.1 [12.0] years) were similar to those of the 40,676 patients who received other antihypertensive drugs (57% female, mean [SD] age, 65.9 [11.8] years). Thirty-day MACEs occurred in 1.3% of patients treated with β-blockers compared with 0.8% of patients not treated with β-blockers (P < .001). β-Blocker use was associated with increased risks of MACEs in 2-drug combinations with RAS inhibitors (odds ratio [OR], 2.16 [95% CI, 1.54-3.04]), calcium antagonists (OR, 2.17 [95% CI, 1.48-3.17]), and thiazides (OR, 1.56 [95% CI, 1.10-2.22]), compared with the reference combination of RAS inhibitors and thiazides. Results were similar for all-cause mortality. Risk of MACEs associated with β-blocker use seemed especially pronounced for patients at least 70 years old (number needed to harm [NNH], 140 [95% CI, 86-364]), for men (NNH, 142 [95% CI, 93-195]), and for patients undergoing acute surgery (NNH, 97 [95% CI, 57-331]), compared with patients younger than 70 years, women, and patients undergoing elective surgery, respectively.
Antihypertensive treatment with a β-blocker may be associated with increased risks of perioperative MACEs and all-cause mortality in patients with uncomplicated hypertension.
围手术期β受体阻滞剂策略对于降低不良事件的风险非常重要。有效性和安全性可能因患者的基线风险而异。
确定在接受非心脏手术的无并发症高血压患者中，长期使用β受体阻滞剂治疗与主要不良心血管事件（MACE）的风险相关。
设计、地点和参与者：这是一项基于丹麦全国范围内的队列研究，该队列包括 2005 年至 2011 年间接受至少两种降压药物（β受体阻滞剂、噻嗪类、钙拮抗剂或肾素-血管紧张素系统[RAS]抑制剂）治疗的无并发症高血压患者。这些患者接受非心脏手术，使用住院记录和院外药物治疗使用情况进行关联研究。
各种降压治疗方案，作为常规治疗的一部分进行选择。
评估 30 天内 MACE（心血管死亡、非致命性缺血性中风、非致命性心肌梗死）和全因死亡率，使用多变量逻辑回归模型和调整需要伤害的人数（NNH）进行评估。
接受β受体阻滞剂治疗的 14644 名患者（65%为女性，平均[SD]年龄 66.1[12.0]岁）的基线特征与接受其他降压药物治疗的 40676 名患者（57%为女性，平均[SD]年龄 65.9[11.8]岁）相似。与未接受β受体阻滞剂治疗的患者（0.8%）相比，接受β受体阻滞剂治疗的患者 30 天内 MACE 的发生率为 1.3%（比值比[OR]，2.16[95%CI，1.54-3.04]）。在与 RAS 抑制剂的二药联合治疗中，β受体阻滞剂的使用与 MACE 风险增加相关（比值比[OR]，2.17[95%CI，1.48-3.17]）、钙拮抗剂（OR，2.17[95%CI，1.48-3.17]）和噻嗪类药物（OR，1.56[95%CI，1.10-2.22]），与 RAS 抑制剂和噻嗪类药物的参考联合治疗相比。全因死亡率的结果相似。与β受体阻滞剂使用相关的 MACE 风险似乎在至少 70 岁的患者中尤为明显（需要伤害的人数[NNH]，140[95%CI，86-364]）、男性（NNH，142[95%CI，93-195]）和接受急症手术的患者（NNH，97[95%CI，57-331]），与年龄小于 70 岁、女性和接受择期手术的患者相比。
在无并发症高血压患者中，使用β受体阻滞剂进行降压治疗可能与围手术期 MACE 和全因死亡率的增加相关。
