Corrao Giovanni, Rea Federico, Monzio Compagnoni Matteo, Merlino Luca, Mancia Giuseppe
aLaboratory of Healthcare Research & Pharmacoepidemiology, Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca bOperative Unit of Territorial Health Services, Region Lombardia cUniversity of Milano-Bicocca and Istituto Auxologico Italiano, Milan, Italy.
J Hypertens. 2017 Jul;35(7):1432-1441. doi: 10.1097/HJH.0000000000001323.
To assess whether in individuals aged 85 years or older, adherence to antihypertensive drugs is accompanied by a reduced risk of cardiovascular events.
A nested case-control study was carried out on a cohort of patients aged 85 years or older, who were newly treated with antihypertensive drugs between 2007 and 2009, using the database available for all citizens (about 10 million) of Lombardy (Italy). Cases were the cohort members who experienced death or hospital discharge for stroke, myocardial infarction (MI) or heart failure from the initial prescription until 2012. Up to five controls were randomly selected for each case. Logistic regression was used to model the outcome risk associated with the adherence with antihypertensive drug therapy. A patient cohort aged 70-84 years was taken for comparison.
Compared with patients with very low adherence, those aged 85 years or older (average 88 years) with high adherence showed a risk reduction for death (47%; 95% confidence interval, 5-57%) and all the outcomes combined (34%; 95% confidence interval, 21-45%). The risk of heart failure and stroke was also reduced, whereas the risk of MI was not affected by adherence with antihypertensive drugs. Similar findings were obtained in the cohort of patients aged 70-84 years.
Adherence with antihypertensive drug therapy reduced the risk of cardiovascular morbidity in patients aged 85 years or more, the benefit including heart failure and stroke, although not MI, and extending to all-cause death.
评估85岁及以上老年人坚持服用抗高血压药物是否会降低心血管事件风险。
对2007年至2009年间开始新接受抗高血压药物治疗的85岁及以上患者队列进行巢式病例对照研究，使用意大利伦巴第大区所有公民（约1000万）的可用数据库。病例为从初始处方至2012年期间因中风、心肌梗死（MI）或心力衰竭而死亡或出院的队列成员。每个病例随机选取多达5名对照。采用逻辑回归对与抗高血压药物治疗依从性相关的结局风险进行建模。选取70 - 84岁的患者队列作为对照。
与依从性极低的患者相比，85岁及以上（平均88岁）且依从性高的患者死亡风险降低（47%；95%置信区间，5 - 57%），所有结局综合风险降低（34%；95%置信区间，21 - 45%）。心力衰竭和中风风险也降低，而MI风险不受抗高血压药物依从性的影响。在70 - 84岁患者队列中也获得了类似结果。
坚持抗高血压药物治疗可降低85岁及以上患者心血管疾病发病率，益处包括心力衰竭和中风，但不包括MI，且可降低全因死亡风险。
