Biodemography of Aging Research Unit, Center for Population Health and Aging, Duke University, Durham, North Carolina, USA.
Department of Surgery, Duke University School of Medicine, Durham, North Carolina, USA.
Am J Hypertens. 2018 Jan 12;31(2):220-227. doi: 10.1093/ajh/hpx151.
This study identifies the effect of intensive drug therapy (IDT) in individuals age 65+ with diabetes (type 2 diabetes mellitus (T2D)) and hypertension on all-cause death, congestive heart failure (CHF), hospitalization for myocardial infarction (MI), and stroke or transient ischemic attack (TIA).
Individuals from the Medicare 5% dataset with hypertension and T2D undergoing IDT for these conditions were propensity score matched to a nonintensive drug-therapy group. Hazard ratios (HRs) were obtained using the Cox proportional hazard model.
IDT was associated with increased risk of CHF (HR 2.32; 95% confidence interval (CI) 2.32-2.38), MI (HR 4.27; 95% CI 4.05-4.52), and stroke or TIA (HR 1.80; 95% CI 1.70-1.89) but decreased risk of death (HR 0.95; 95% CI 0.93-0.97). Risk for CHF (HR 0.73; 95% CI 0.71-0.73), MI (HR 0.64; 95% CI 0.62-0.67), stroke or TIA (HR 0.82; 95% CI 0.78-0.86), and death (HR 0.29; 95% CI 0.28-0.29) was decreased by adherence to diabetes management guidelines.
Use of IDT in a high-risk population delays death but not severe macrovascular outcomes. Protective effects of IDT in high-risk patients likely outweigh polypharmacy-related health concerns.
本研究旨在确定强化药物治疗（IDT）对 65 岁以上合并糖尿病（2 型糖尿病（T2DM））和高血压的个体全因死亡、充血性心力衰竭（CHF）、心肌梗死（MI）住院、卒中和短暂性脑缺血发作（TIA）的影响。
从 Medicare 5%数据集中选择患有高血压和 T2DM 且正在接受这些疾病 IDT 的个体，通过倾向评分匹配到非强化药物治疗组。使用 Cox 比例风险模型获得风险比（HR）。
IDT 与 CHF（HR 2.32；95%置信区间（CI）2.32-2.38）、MI（HR 4.27；95% CI 4.05-4.52）和卒中和 TIA（HR 1.80；95% CI 1.70-1.89）风险增加相关，但与死亡风险降低相关（HR 0.95；95% CI 0.93-0.97）。CHF（HR 0.73；95% CI 0.71-0.73）、MI（HR 0.64；95% CI 0.62-0.67）、卒中和 TIA（HR 0.82；95% CI 0.78-0.86）以及死亡（HR 0.29；95% CI 0.28-0.29）的风险降低与糖尿病管理指南的依从性有关。
在高危人群中使用 IDT 可延迟死亡，但不能改善严重大血管结局。IDT 在高危患者中的保护作用可能超过与多药治疗相关的健康问题。
