抗高血压药物类别与老年人跌倒的相关性：系统评价和荟萃分析。

Association Between Chronic or Acute Use of Antihypertensive Class of Medications and Falls in Older Adults. A Systematic Review and Meta-Analysis.

机构信息

The University of Sydney, Faculty of Pharmacy, Sydney, New South Wales, Australia.

Royal Prince Alfred Hospital, Geriatric Medicine, New South Wales, Australia.

出版信息

Am J Hypertens. 2018 Mar 10;31(4):467-479. doi: 10.1093/ajh/hpx189.

DOI:10.1093/ajh/hpx189

PMID:29087440

Abstract

BACKGROUND

Evaluating effect of acute or chronic use of antihypertensives on risk of falls in older adults.

METHODS

Data sources: Systematic search of primary research articles in CINAHL, Cochrane, EBM, EMBASE, and MEDLINE databases from January 1 2007 to June 1 2017. Study selection: Research studies of cohort, case-control, case-crossover, cross-sectional, or randomized controlled trial (RCT) design examining association between antihypertensives and falls in people older than 60 years were evaluated. Data synthesis: Twenty-nine studies (N = 1,234,667 participants) were included. Study quality was assessed using the Newcastle-Ottawa Scale (NOS). PRISMA and MOOSE guidelines were used for abstracting data and random-effects inverse-variance meta-analysis was conducted on 26 articles examining chronic antihypertensive use, with odds ratios (ORs) and hazards ratios (HRs) analyzed separately. Time-risk analysis was performed on 5 articles examining acute use of antihypertensives. Outcomes: Pooled ORs and HRs were calculated to determine the association between chronic antihypertensive use and falls. For time-risk analysis, OR was plotted with respect to number of days since antihypertensive commencement, change, or dose increase.

RESULTS

There was no significant association between risk of falling and chronic antihypertensive medication use (OR = 0.97, 95% confidence interval [CI] 0.93-1.01, I2 = 64.1%, P = 0.000; and HR = 0.96, 95% CI 0.92-1.00, I2 = 0.0%, P = 0.706). The time-risk analysis demonstrated a significantly elevated risk of falling 0-24 hours after antihypertensive initiation, change, or dose increase. When diuretics were used, the risk remained significantly elevated till day 21.

CONCLUSIONS

There is no significant association between chronic use of antihypertensives and falls in older adults. Risk of falls is highest on day zero for all antihypertensive medications.

摘要

背景

评估降压药急性或慢性使用对老年人跌倒风险的影响。

方法

数据来源：系统检索 CINAHL、Cochrane、EBM、EMBASE 和 MEDLINE 数据库中 2007 年 1 月 1 日至 2017 年 6 月 1 日的原始研究文章。研究选择：评估降压药与 60 岁以上人群跌倒之间关联的队列、病例对照、病例交叉、横断面或随机对照试验（RCT）研究。数据综合：共纳入 29 项研究（N=1234667 名参与者）。使用纽卡斯尔-渥太华量表（NOS）评估研究质量。使用 PRISMA 和 MOOSE 指南提取数据，并对 26 项关于慢性使用降压药的文章进行随机效应逆方差荟萃分析，分别分析比值比（OR）和风险比（HR）。对 5 项关于急性使用降压药的文章进行时间风险分析。结果：计算汇总 OR 和 HR，以确定慢性使用降压药与跌倒之间的关联。对于时间风险分析，将 OR 相对于开始使用降压药、改变或增加剂量后的天数绘制。

结果

慢性使用降压药与跌倒风险无显著关联（OR=0.97，95%置信区间[CI]0.93-1.01，I2=64.1%，P=0.000；HR=0.96，95%CI0.92-1.00，I2=0.0%，P=0.706）。时间风险分析显示，降压药开始、改变或增加剂量后 0-24 小时内跌倒风险显著升高。使用利尿剂时，风险持续到第 21 天仍显著升高。