Center for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia; Aging Research Center, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden.
Aging Research Center, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden.
J Am Med Dir Assoc. 2018 Jul;19(7):577-583. doi: 10.1016/j.jamda.2017.11.017. Epub 2018 Jan 3.
To investigate the association between antihypertensive medication regimen intensity and risk of incident dementia in an older population.
Prospective, longitudinal cohort study.
PARTICIPANTS/SETTING: A total of 1208 participants aged ≥78 years, free of dementia, and residing in central Stockholm at baseline (2001-2004).
Participants were examined at 3- and 6-year follow-up to detect incident dementia. Data were collected through face-to-face interviews, clinical examinations, and laboratory tests. Data on antihypertensive use were obtained by a physician through patient self-report, visual inspection, or medical records. Cox proportional hazards models were used to compute hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between time-varying antihypertensive regimen intensity and incident dementia after adjusting for potential confounders.
During the follow-up period, 125 participants were diagnosed with dementia. Participants who developed dementia were more likely to have vascular disease at baseline (66.4% vs 55.3%, P = .02). In fully adjusted analyses, the number of antihypertensive classes (HR 0.68, 95% CI 0.55-0.84) and total prescribed daily dose (HR 0.70, 95% CI 0.57-0.86) were significantly associated with reduced dementia risk. After considering all-cause mortality as a competing risk, the number (HR 0.75, 95% CI 0.62-0.91) and doses (HR 0.71, 95% CI 0.59-0.86) of antihypertensive classes, and the independent use of diuretics (HR 0.66, 95% CI 0.44-0.99), were significantly associated with lower dementia risk.
Greater intensity of antihypertensive drug use among older people may be associated with reduced incidence of dementia.
探讨老年人群中降压药物治疗方案强度与新发痴呆风险的关系。
前瞻性、纵向队列研究。
参与者/设置：共有 1208 名年龄≥78 岁、无痴呆且基线时居住在斯德哥尔摩市中心的参与者（2001-2004 年）。
在 3 年和 6 年随访时对参与者进行检查，以发现新发痴呆病例。数据通过面对面访谈、临床检查和实验室测试收集。通过医生从患者自述、视觉检查或病历中获取降压药物使用数据。使用 Cox 比例风险模型计算时变降压药物治疗方案强度与调整潜在混杂因素后的新发痴呆之间的关联的风险比（HR）和 95%置信区间（CI）。
在随访期间，125 名参与者被诊断为痴呆。发生痴呆的参与者在基线时更可能患有血管疾病（66.4%比 55.3%，P=.02）。在完全调整分析中，降压药物种类的数量（HR 0.68，95%CI 0.55-0.84）和总处方日剂量（HR 0.70，95%CI 0.57-0.86）与降低痴呆风险显著相关。在考虑全因死亡率作为竞争风险后，降压药物种类的数量（HR 0.75，95%CI 0.62-0.91）和剂量（HR 0.71，95%CI 0.59-0.86）以及独立使用利尿剂（HR 0.66，95%CI 0.44-0.99）与降低痴呆风险显著相关。
老年人中降压药物使用强度的增加可能与痴呆发病率的降低有关。
