Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore, Republic of Singapore.
Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore, Republic of Singapore.
BMC Geriatr. 2018 Aug 28;18(1):195. doi: 10.1186/s12877-018-0871-7.
This study aimed to determine whether the number of anti-hypertensive medication classes or any change in anti-hypertensive medication were associated with injurious fall among the community-dwelling older population of low socioeconomic status.
Using data from electronic medical records, we performed a nested case-control study among older Singapore residents (≥60) of low socioeconomic status (N = 210). Controls (n = 162) were matched to each case (n = 48) by age and gender. Variables with p < 0.10 in univariate analysis were included in multivariate analysis. We used conditional logistic regression to assess the associations of the number of anti-hypertensive medication classes and change in anti-hypertensive medication with injurious falls. We also performed stepwise regressions as sensitivity analyses. p < 0.05 was considered statistically significant.
The mean (±SD) age of participants was 78.1 (± 8.33) years; 127 (60.4%) were female, 189 (90.0%) were Chinese. Those on ≥2 anti-hypertensive medication classes had an increased risk of experiencing an injurious fall compared to those not on any anti-hypertensive medication (OR = 5.45; CI:1.49-19.93; p = 0.01). Among those who were taking anti-hypertensive medication, those who had a change in the medication 180-day prior to injurious fall had a significantly increased risk of experiencing an injurious fall compared to those that did not report any change in anti-hypertensive medication (OR = 3.88; CI:1.23-12.19; p = 0.02). Sensitivity analyses generated consistent findings.
Both ≥2 anti-hypertensive medication classes and change in anti-hypertensive medication were associated with an increased risk of experiencing an injurious fall among the older population of low socioeconomic status. Our findings could guide prescribers to exercise caution in the initiation of anti-hypertensive medications or in making medication changes, especially among the older population of low socioeconomic status.
本研究旨在确定抗高血压药物种类的数量或抗高血压药物的任何变化是否与社会经济地位较低的社区居住老年人的伤害性跌倒有关。
使用电子病历数据，我们在社会经济地位较低的新加坡老年居民（≥60 岁）中进行了嵌套病例对照研究（N=210）。对照组（n=162）按年龄和性别与每个病例（n=48）匹配。单变量分析中 p<0.10 的变量被纳入多变量分析。我们使用条件逻辑回归评估抗高血压药物种类数量和抗高血压药物变化与伤害性跌倒的关联。我们还进行了逐步回归作为敏感性分析。p<0.05 被认为具有统计学意义。
参与者的平均（±SD）年龄为 78.1（±8.33）岁；127 人（60.4%）为女性，189 人（90.0%）为中国人。与未服用任何抗高血压药物的患者相比，服用≥2 种抗高血压药物的患者发生伤害性跌倒的风险增加（OR=5.45；95%CI：1.49-19.93；p=0.01）。在服用抗高血压药物的患者中，与未报告抗高血压药物任何变化的患者相比，在伤害性跌倒前 180 天药物变化的患者发生伤害性跌倒的风险显著增加（OR=3.88；95%CI：1.23-12.19；p=0.02）。敏感性分析得出了一致的结果。
≥2 种抗高血压药物种类和抗高血压药物的变化与社会经济地位较低的老年人群发生伤害性跌倒的风险增加有关。我们的研究结果可以指导医生在开始抗高血压药物治疗或进行药物调整时谨慎行事，尤其是在社会经济地位较低的老年人群中。
