Barzilay Joshua I, Davis Barry R, Pressel Sara L, Ghosh Alokananda, Puttnam Rachel, Margolis Karen L, Whelton Paul K
Division of Endocrinology, Kaiser Permanente of Georgia, 3650 Steve Reynolds Blvd, Duluth, Atlanta, GA, 30096, USA.
Coordinating Center for Clinical Trials, the University of Texas School of Public Health, Houston, TX, USA.
Curr Cardiol Rep. 2017 Sep;19(9):76. doi: 10.1007/s11886-017-0888-0.
This review summarizes the impact of thiazide diuretics on fracture risk in older hypertensive individuals.
We performed a post hoc evaluation of the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial, a randomized, prospective, double blind hypertension study comparing a thiazide-like diuretic, a calcium channel blocker (CCB), and an angiotensin converting enzyme inhibitor (ACEi). We examined the risk of hip and pelvic fractures during the in-trial period (n = 22,180 participants; mean 4.9-year follow-up) and during the post-trial period using national data bases (n = 16,622 participants) (mean total follow-up 7.8 years). During the trial, participants randomized to the thiazide diuretic versus the CCB or the ACEi had a lower risk of fracture on adjusted analyses (HR 0.79 [95% CI, 0.63, 0.98], p = 0.04). Risk of fracture was significantly lower in participants randomized to the diuretic as compared to those randomized to the ACEi (HR 0.75 [95% CI, 0.58, 0.98]; p = 0.04), but not significantly different compared to the CCB (HR 0.87 [95% CI, 0.71, 1.09]; p = 0.17). Over the entire trial and post-trial period of follow-up, the cumulative incidence of fractures was non-significantly lower in participants assigned to the diuretic vs assignment to the ACEi or the CCB (HR 0.87 [0.74-1.03], p = 0.10) and versus each medication separately. These findings establish a benefit for thiazide diuretic treatment for the prevention of fractures versus other commonly used antihypertensive medications using prospective, randomized data. The effects of the thiazide diuretic on bone appear to be long lasting.
本综述总结了噻嗪类利尿剂对老年高血压患者骨折风险的影响。
我们对预防心脏病发作的降压和降脂治疗试验进行了事后评估，这是一项随机、前瞻性、双盲高血压研究，比较了一种噻嗪样利尿剂、一种钙通道阻滞剂（CCB）和一种血管紧张素转换酶抑制剂（ACEi）。我们使用国家数据库，研究了试验期间（n = 22180名参与者；平均随访4.9年）和试验后期间（n = 16622名参与者）（平均总随访7.8年）髋部和骨盆骨折的风险。在试验期间，经调整分析，随机接受噻嗪类利尿剂治疗的参与者与接受CCB或ACEi治疗的参与者相比，骨折风险较低（HR 0.79 [95% CI，0.63，0.98]，p = 0.04）。与随机接受ACEi治疗的参与者相比，随机接受利尿剂治疗的参与者骨折风险显著降低（HR 0.75 [95% CI，0.58，0.98]；p = 0.04），但与CCB相比无显著差异（HR 0.87 [95% CI，0.71，1.09]；p = 0.17）。在整个试验和试验后随访期间，接受利尿剂治疗的参与者骨折的累积发生率与接受ACEi或CCB治疗的参与者相比无显著降低（HR 0.87 [0.74 - 1.03]，p = 0.10），与每种药物单独相比也是如此。这些发现通过前瞻性、随机数据证实了噻嗪类利尿剂治疗在预防骨折方面优于其他常用降压药物。噻嗪类利尿剂对骨骼的影响似乎是持久的。
