术前使用抗高血压药物与非心脏手术后 90 天死亡率的关系：一项回顾性队列研究。

Association Between Use of Preoperative Antihypertensive Medication and 90-Day Mortality After Noncardiac Surgery: A Retrospective Cohort Study.

机构信息

Interdepartment of Critical Care Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea.

Department of Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea.

出版信息

Am J Hypertens. 2020 May 21;33(6):534-542. doi: 10.1093/ajh/hpaa012.

DOI:10.1093/ajh/hpaa012

PMID:31956912

Abstract

BACKGROUND

This study aimed to determine whether use of preoperative antihypertensive medication is associated with postoperative 90-day mortality in the hypertensive adult population that underwent elective noncardiac surgery.

METHODS

In this retrospective cohort study, medical records of preoperative hypertensive patients who underwent noncardiac surgery at a single tertiary academic hospital from 2012 to 2018 were reviewed. Among the hypertensive patients, those prescribed to take antihypertensive medication continuously for more than 1 month before admission were defined as the HTN MED group; others were defined as the non-HTN MED group. Multiple imputation, propensity score (PS) matching, and logistic regression analysis were used for statistical analysis.

RESULTS

Overall, 35,589 preoperative hypertensive adult patients (HTN MED group: 26,154 patients, non-HTN MED group: 9,435 patients) were included in the analysis. After PS matching, each group comprised 6,205 patients; thus, 12,410 patients were included in the final analysis. The odds for 90-day mortality of the HTN MED group in the PS-matched cohort were 41% lower (odds ratio: 0.59, 95% confidence interval: 0.41-0.85; P = 0.005) than those of the non-HTN MED group. Comparable results were obtained in the multivariable logistic regression analysis of the entire cohort (odds ratio: 0.54, 95% confidence interval: 0.41-0.72; P < 0.001).

CONCLUSIONS

This study showed that the use of preoperative antihypertensive medication was associated with lower 90-day mortality among hypertensive patients who underwent noncardiac surgery. Therefore, preoperative screening and treatment with appropriate antihypertensive medication are important for hypertensive patients.

摘要

背景

本研究旨在确定接受择期非心脏手术的高血压成年人群中，术前使用降压药物是否与术后 90 天死亡率相关。

方法

在这项回顾性队列研究中，对 2012 年至 2018 年期间在一家三级学术医院接受非心脏手术的术前高血压患者的病历进行了回顾。在高血压患者中，术前连续服用降压药物超过 1 个月的患者被定义为 HTN MED 组；其他人被定义为非-HTN MED 组。采用多重插补、倾向评分（PS）匹配和逻辑回归分析进行统计分析。

结果

总体而言，共纳入 35589 例术前高血压成年患者（HTN MED 组：26154 例，非-HTN MED 组：9435 例）进行分析。经过 PS 匹配后，每组各包含 6205 例患者；因此，最终分析纳入了 12410 例患者。PS 匹配队列中 HTN MED 组的 90 天死亡率的比值比（OR）为 41%（OR：0.59，95%置信区间：0.41-0.85；P=0.005）低于非-HTN MED 组。在整个队列的多变量逻辑回归分析中也得到了类似的结果（OR：0.54，95%置信区间：0.41-0.72；P<0.001）。