Internal Medicine and Geriatrics, "Hypertension Excellence Centre" of the European Society of Hypertension, IRCCS-INRCA "U. Sestilli," Ancona, Italy; Department of Clinical and Molecular Sciences, University "Politecnica delle Marche," Ancona, Italy.
Internal Medicine and Geriatrics, "Hypertension Excellence Centre" of the European Society of Hypertension, IRCCS-INRCA "U. Sestilli," Ancona, Italy; Department of Clinical and Molecular Sciences, University "Politecnica delle Marche," Ancona, Italy.
J Am Med Dir Assoc. 2018 Apr;19(4):342-347. doi: 10.1016/j.jamda.2017.09.023. Epub 2017 Nov 8.
Cardiovascular diseases are mainly related to hypertension and dyslipidemia and increase with aging because of the larger time span for these risk factors to damage arterial blood vessels. The impact of cardiovascular drug therapy on outcomes in the very elderly hospitalized is still not well established. The aim of our study was to evaluate the associations between cardiovascular therapy and in-hospital mortality in very elderly hypertensives.
Prospective observational study.
Hospital assessment.
310 very elderly hypertensive patients admitted to our Internal Medicine and Geriatrics Department for medical conditions.
Main comorbidities, laboratory parameters, and cardiovascular drug therapy taken before admission were considered for the analyses.
The mean age was 88.1 ± 5.1 years, with female prevalence of 57.4%. Among cardiovascular drugs taken before admission, angiotensin-converting enzyme (ACE) inhibitors/angiotensin receptor blockers and statins were those associated with lower in-hospital mortality, even after adjusting for covariates (age, hemoglobin, albumin, acute kidney injury, ADL Hierarchy Scale, NT-proBNP levels) [odds ratio (OR) = 0.46, P = .045, and OR = 0.21, P = .008, respectively]. No difference regarding in-hospital mortality was found between ACE inhibitors and angiotensin receptor blockers (P = .414).
ACE inhibitors/angiotensin receptor blockers and statins, through their beneficial effects on the cardiovascular system, have a positive impact on survival in very elderly hospitalized patients. Our data confirm the important role of such drugs even in this particular population with a mean age higher than 88 years, where scientific evidence is still scanty.
心血管疾病主要与高血压和血脂异常有关，并随着年龄的增长而增加，因为这些危险因素损害动脉血管的时间跨度更大。心血管药物治疗对住院超高龄患者结局的影响仍未得到充分证实。我们的研究旨在评估心血管治疗与超高龄高血压患者住院期间死亡率之间的关系。
前瞻性观察性研究。
医院评估。
310 名因医疗状况入住我院内科和老年科的超高龄高血压患者。
分析考虑了主要合并症、实验室参数和入院前接受的心血管药物治疗。
平均年龄为 88.1±5.1 岁，女性患病率为 57.4%。在入院前服用的心血管药物中，血管紧张素转换酶（ACE）抑制剂/血管紧张素受体阻滞剂和他汀类药物与较低的住院期间死亡率相关，即使在调整了协变量（年龄、血红蛋白、白蛋白、急性肾损伤、日常生活活动量表、NT-proBNP 水平）后也是如此 [比值比（OR）=0.46，P=0.045 和 OR=0.21，P=0.008]。ACE 抑制剂和血管紧张素受体阻滞剂在住院期间死亡率方面没有差异（P=0.414）。
ACE 抑制剂/血管紧张素受体阻滞剂和他汀类药物通过对心血管系统的有益作用，对住院超高龄患者的生存产生积极影响。我们的数据证实了这些药物的重要作用，即使在平均年龄超过 88 岁的这一特定人群中，科学证据仍然有限。
