抗高血压药物的使用、血压变异性与老年人中风风险的相关性：三城市队列研究。

Antihypertensive Drug Use, Blood Pressure Variability, and Incident Stroke Risk in Older Adults: Three-City Cohort Study.

机构信息

From the University of Bordeaux, Department of Neuroepidemiology, Bordeaux, France (P.J.T., S.D., C.T.); Freemasons Foundation Centre for Men's Health, Discipline of Medicine, School of Medicine, The University of Adelaide, Australia (P.J.T.); Department of Neurology, Bordeaux University Hospital, Bordeaux, France (S.D.); Department of Neurology, Framingham Heart Study, Boston University School of medicine, MA (S.D.); Department of Epidemiology and Biostatistics, Institut National de la Santé et de la Recherche Médicale U897, University of Bordeaux, Bordeaux, France (J.-F.D., C.H.); INSERM U1061, La Colombière Hospital, University of Montpellier UM1, Montpellier, France (S.A.); and INSERM, Department of Neuroepidemiology, UMR897, F-33000 Bordeaux, France (P.J.T., C.T.).

出版信息

Stroke. 2016 May;47(5):1194-200. doi: 10.1161/STROKEAHA.115.012321. Epub 2016 Mar 24.

DOI:10.1161/STROKEAHA.115.012321

PMID:27012741

Abstract

BACKGROUND AND PURPOSE

The aim was to determine the association between antihypertensive drug class and incident stroke controlling for long-term blood pressure (BP) variability (BPV) in people aged ≥65 years.

METHODS

The sample included 5951 participants (median age 74 years, 60% women) taking at least 1 drug for hypertension (3727/5951) or with systolic BP >140 mm Hg or diastolic BP >90 mm Hg. Participants were evaluated for incident fatal and nonfatal stroke to 12 years follow-up. BPV was calculated with the coefficient of variation method and regressed against 9 antihypertensive drug classes (BPVreg). Hazard models were used to determine hazard ratios for incident stroke risk attributable to drug class, adjusted for BP, BPVreg, covariates, and delayed entry bias.

RESULTS

There were 273 incident strokes over a median of 9.1 years (interquartile range 6.4-10.4). Stroke risk was generally not reduced by BP-lowering drugs. Angiotensin receptor blockers (hazard ratio 1.56; 95% confidence interval 1.06-2.28; P=0.02) and β-blockers (hazard ratio 1.41; 95% confidence interval 1.03-1.92; P=0.03) were associated with an increased total stroke risk. Angiotensin receptor blockers and β-blockers were also associated with ischemic strokes after adjustment for systolic BPV. Diastolic BPV was associated with stroke risk in analyses stratified by systolic BP 140 to 160 mm Hg (per 0.10 increase in coefficient of variation, hazard ratio 1.59; 95% confidence interval 1.05-2.40; P=0.03).

CONCLUSIONS

The angiotensin receptor blocker and β-blocker drug classes were associated with incident stroke and ischemic stroke in older adults. BPV was generally not associated with incident stroke.

摘要

背景与目的

本研究旨在确定在≥65 岁人群中，在控制长期血压变异性（BPV）的情况下，降压药物类别与卒中事件之间的关联。

方法

本研究纳入了 5951 名参与者（中位年龄 74 岁，60%为女性），他们至少服用了 1 种降压药物（3727/5951）或收缩压>140mmHg 或舒张压>90mmHg。参与者在 12 年的随访中评估了致死性和非致死性卒中的发生情况。采用变异系数法计算 BPV，并回归分析 9 种降压药物类别（BPVreg）。采用风险模型，在校正血压、BPVreg、协变量和延迟进入偏倚后，确定药物类别与卒中风险之间的比值比（HR）。

结果

中位随访时间为 9.1 年（四分位距为 6.4-10.4）期间，共发生了 273 例卒中事件。降压药物通常并不能降低卒中风险。血管紧张素受体阻滞剂（HR 1.56；95%置信区间为 1.06-2.28；P=0.02）和β受体阻滞剂（HR 1.41；95%置信区间为 1.03-1.92；P=0.03）与总卒中风险增加相关。在调整收缩压 BPV 后，血管紧张素受体阻滞剂和β受体阻滞剂也与缺血性卒中相关。在按收缩压 140-160mmHg 分层的分析中，舒张压 BPV 与卒中风险相关（每增加 0.10 变异系数，HR 为 1.59；95%置信区间为 1.05-2.40；P=0.03）。