Yeh Chao-Bin, Tsai Ming-Che, Teng Ying-Hock, Ku Min-Sho, Huang Jing-Yang, Wang Bo-Yuan, Tai Chia-Ling, Kornelius Edy, Ho Sai-Wai
Department of Emergency Medicine, School of Medicine, Chung Shan Medical University, Taichung, Taiwan.
Department of Emergency Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan.
J Eval Clin Pract. 2020 Jun;26(3):983-991. doi: 10.1111/jep.13254. Epub 2019 Aug 6.
Anxiety is a mediator for emotional reactivity and acute blood pressure elevations, which are associated with an increased risk of cardiovascular death. Alprazolam is a common medication for anxiolysis. We hypothesized that alprazolam usage can reduce the risk of major adverse cardiovascular events (MACEs) in patients with hypertension.
A retrospective cohort study was performed using datasets from Taiwanese Health and Welfare Data. Patients with hypertension were divided into exposed (Alprazolam-exposed) and control groups (non-Alprazolam-exposed) with 1:1 propensity score matching. The study endpoint was the occurrence of MACE. Adjusted hazard ratio (aHR) of MACE risk was estimated using the multiple Cox proportional hazard model. Age-stratified analysis was performed to evaluate the interaction of age and alprazolam use with MACEs.
The study cohort consisted of 335 517 alprazolam-exposed patients and 1:1 PSM controls. The mean age was 63.62 ± 12.71 years in the Alprazolam-exposed population. Alprazolam exposure was significantly associated with reduced risk of MACEs (aHR = 0.965, 95% CI = 0.954-0.977), including ischemic stroke (aHR = 0.958, 95% CI = 0.940-0.976), hemorrhagic stroke (aHR = 0.856, 95% CI = 0.821-0.892), myocardial infarction (aHR = 0.933, 95% CI = 0.900-0.968), sudden cardiac death (aHR = 0.955, 95% CI = 0.916-0.996), and all-cause mortality (aHR = 0.921, 95% CI = 0.909-0.932). In the age-subgroup analysis, alprazolam showed the greatest risk reduction effect in hemorrhagic stroke for patients aged <65 years (aHR = 0.779, 95% CI = 0.727-0.835).
Alprazolam usage in patients with hypertension was associated with a slightly reduced risk of MACEs and all-cause mortality, and up to 22% reduced risk of hemorrhagic stroke was observed in alprazolam users aged <65 years.
焦虑是情绪反应和急性血压升高的介导因素，而这与心血管死亡风险增加相关。阿普唑仑是一种常用的抗焦虑药物。我们假设，使用阿普唑仑可降低高血压患者发生主要不良心血管事件（MACE）的风险。
利用台湾健康与福利数据集中的数据进行一项回顾性队列研究。高血压患者通过1:1倾向评分匹配被分为暴露组（阿普唑仑暴露组）和对照组（非阿普唑仑暴露组）。研究终点为MACE的发生情况。使用多重Cox比例风险模型估计MACE风险的调整后风险比（aHR）。进行年龄分层分析以评估年龄和阿普唑仑使用与MACE之间的相互作用。
研究队列包括335517名阿普唑仑暴露患者及其1:1倾向评分匹配的对照。阿普唑仑暴露人群的平均年龄为63.62±12.71岁。阿普唑仑暴露与MACE风险降低显著相关（aHR = 0.965，95%CI = 0.954 - 0.977），包括缺血性卒中（aHR = 0.958，95%CI = 0.940 - 0.976）、出血性卒中（aHR = 0.856，95%CI = 0.821 - 0.892）、心肌梗死（aHR = 0.933，95%CI = 0.900 - 0.968）、心源性猝死（aHR = 0.955，95%CI = 0.916 - 0.996）和全因死亡率（aHR = 0.921，95%CI = 0.909 - 0.932）。在年龄亚组分析中，阿普唑仑在年龄<65岁的患者出血性卒中方面显示出最大的风险降低效果（aHR = 0.779，95%CI = 0.727 - 0.835）。
高血压患者使用阿普唑仑与MACE和全因死亡率风险略有降低相关，并且在年龄<65岁的阿普唑仑使用者中观察到出血性卒中风险降低高达22%。
