老年患者使用不同种类降压药物可降低痴呆风险。
Lower dementia risk with different classes of antihypertensive medication in older patients.
作者信息
van Middelaar Tessa, van Vught Lonneke A, Moll van Charante Eric P, Eurelings Lisa S M, Ligthart Suzanne A, van Dalen Jan W, van den Born Bert Jan H, Richard Edo, van Gool Willem A
机构信息
aDepartment of Neurology, Academic Medical Center (AMC), Amsterdam bDepartment of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen cDepartment of General Practice, Amsterdam Public Health Research Institute dDepartment of Internal Medicine, Academic Medical Center (AMC), Amsterdam, the Netherlands.
出版信息
J Hypertens. 2017 Oct;35(10):2095-2101. doi: 10.1097/HJH.0000000000001411.
OBJECTIVE
Use of antihypertensive medication (AHM) is potentially associated with a reduced risk of dementia. Both calcium channel blockers (CCBs) and angiotensin receptor blockers (ARBs) are suggested to have a more pronounced protective effect. We aimed to study the association between different classes of AHM and dementia in older people.
METHODS
A subgroup of community-dwelling older people using AHM included in the 'Prevention of Dementia by Intensive Vascular Care' randomized controlled trial was studied. Incident dementia rates in participants with different AHM classes (mono and combination therapy) were compared with dementia rates in participants with any other AHM.
RESULTS
At baseline, 1951 participants (55.3%) used AHM [mean age, 74.4 year (SD 2.5); mean SBP, 156.4 mmHg (SD 21.5)]. In total, 986 participants (50.5%) used β-blockers, 798 diuretics (40.9%), 623 angiotensin- converting enzyme inhibitors (31.9%), 522 CCBs (26.8%), and 402 ARBs (20.6%). After 6.7 years (interquartile range 6.0-7.3) of follow-up, 136 participants (7.0%) developed dementia. Both use of CCBs [hazard ratio 0.56, 95% confidence interval (95% CI) 0.36-0.87] and ARBs (hazard ratio 0.60, 95% CI 0.37-0.98) were independently associated with a decreased risk of dementia. The association of CCBs with dementia was most apparent in participants without a history of cardiovascular disease (hazard ratio 0.38, 95% CI 0.18-0.81) and with uncontrolled hypertension (hazard ratio 0.26, 95% CI 0.11-0.61). SBP was not significantly lower in participants using CCBs or ARBs.
CONCLUSION
Both use of CCBs and ARBs are independently associated with a decreased risk of dementia in older people.
目的
使用抗高血压药物（AHM）可能与降低痴呆风险有关。钙通道阻滞剂（CCB）和血管紧张素受体阻滞剂（ARB）都被认为具有更显著的保护作用。我们旨在研究老年人中不同类别AHM与痴呆之间的关联。
方法
对“强化血管护理预防痴呆”随机对照试验中使用AHM的社区居住老年人亚组进行研究。比较不同AHM类别（单药治疗和联合治疗）参与者的痴呆发病率与使用其他任何AHM参与者的痴呆发病率。
结果
在基线时，1951名参与者（55.3%）使用AHM[平均年龄74.4岁（标准差2.5）；平均收缩压156.4 mmHg（标准差21.5）]。总共有986名参与者（50.5%）使用β受体阻滞剂，798名使用利尿剂（40.9%），623名使用血管紧张素转换酶抑制剂（31.9%），522名使用CCB（26.8%），402名使用ARB（20.6%）。经过6.7年（四分位间距6.0 - 7.3）的随访，136名参与者（7.0%）患上痴呆。使用CCB[风险比0.56，95%置信区间（95%CI）0.36 - 0.87]和ARB（风险比0.60，95%CI 0.37 - 0.98）均与痴呆风险降低独立相关。CCB与痴呆的关联在无心血管疾病史的参与者中最为明显（风险比0.38，95%CI 0.18 - 0.81）以及在高血压未得到控制的参与者中（风险比0.26，95%CI 0.11 - 0.61）。使用CCB或ARB的参与者收缩压没有显著降低。
结论
使用CCB和ARB均与老年人痴呆风险降低独立相关。
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