Leeds Institute of Biomedical and Clinical Sciences (Mebrahtu); Leeds Institute of Cardiovascular and Metabolic Medicine (Morgan), School of Medicine, University of Leeds; NIHR Biomedical Research Centre (Morgan, Stewart), Leeds Teaching Hospitals NHS Trust, Chapel Allerton Hospital; Leeds Institute of Health Sciences, (West, Pujades-Rodriguez), School of Medicine; Dean's office, Faculty of Medicine & Health (Stewart), University of Leeds, Leeds, UK.
Leeds Institute of Biomedical and Clinical Sciences (Mebrahtu); Leeds Institute of Cardiovascular and Metabolic Medicine (Morgan), School of Medicine, University of Leeds; NIHR Biomedical Research Centre (Morgan, Stewart), Leeds Teaching Hospitals NHS Trust, Chapel Allerton Hospital; Leeds Institute of Health Sciences, (West, Pujades-Rodriguez), School of Medicine; Dean's office, Faculty of Medicine & Health (Stewart), University of Leeds, Leeds, UK
CMAJ. 2020 Mar 23;192(12):E295-E301. doi: 10.1503/cmaj.191012.
Only a few population-based studies have examined the association between glucocorticoids and hypertension, with inconsistent results. We aimed to investigate the effect of oral glucocorticoids on incidence of hypertension in adults with chronic inflammatory diseases.
We analyzed electronic health records from 389 practices in England during 1998-2017 of adults diagnosed with any of 6 chronic inflammatory diseases but with no previous diagnosis of hypertension. We used glucocorticoid prescription data to construct time-variant daily and cumulative variables of prednisolone-equivalent dose (cumulated from 1 year before the start of follow-up) and estimated incidence rates and adjusted hazard ratios (HRs) for hypertension using Cox regression analysis.
Among 71 642 patients in the cohort, 24 896 (34.8%) developed hypertension during a median follow-up of 6.6 years. The incidence rate of hypertension was 46.7 (95% confidence interval [CI] 46.0-47.3) per 1000 person-years. Incidence rates increased with higher cumulative glucocorticoid prednisolone-equivalent dose, from 44.4 per 1000 person-years in periods of nonuse to 45.3 per 1000 person-years for periods with between > 0.0 and 959.9 mg (HR 1.14, 95% CI 1.09-1.19), to 49.3 per 1000 person-years for periods with 960-3054.9 mg (HR 1.20, 95% CI 1.14-1.27), and to 55.6 per 1000 person-years for periods with ≥ 3055 mg (HR 1.30, 95% CI 1.25-1.35). Cumulative effects were seen for the 6 diseases studied, but dose-response effects were not found for daily dose.
Cumulative dose of oral glucocorticoids was associated with increased incidence of hypertension, suggesting that blood pressure should be monitored closely in patients routinely treated with these drugs. Given that glucocorticoids are widely prescribed, the associated health burden could be high. ClinicalTrials. gov, no. NCT03760562.
仅有少数基于人群的研究探讨了糖皮质激素与高血压之间的关联，但结果并不一致。我们旨在调查口服糖皮质激素对患有慢性炎症性疾病的成年人高血压发病率的影响。
我们分析了 1998 年至 2017 年期间英格兰 389 家诊所的电子健康记录，这些患者被诊断患有 6 种慢性炎症性疾病中的任何一种，但之前没有高血压诊断。我们使用糖皮质激素处方数据构建了时间变化的每日和累积泼尼松当量剂量变量（从随访开始前 1 年累积），并使用 Cox 回归分析估计了高血压的发病率和调整后的风险比（HR）。
在队列中的 71642 名患者中，24896 名（34.8%）在中位随访 6.6 年内发生了高血压。高血压的发病率为 46.7（95%置信区间[CI] 46.0-47.3）/1000 人年。发病率随累积糖皮质激素泼尼松当量剂量的增加而增加，从不使用时期的 44.4/1000 人年到使用时期的 0.0-959.9mg 期间的 45.3/1000 人年（HR 1.14，95%CI 1.09-1.19），再到使用时期的 960-3054.9mg 期间的 49.3/1000 人年（HR 1.20，95%CI 1.14-1.27），再到使用时期的 ≥3055mg 期间的 55.6/1000 人年（HR 1.30，95%CI 1.25-1.35）。在研究的 6 种疾病中均观察到了累积效应，但未发现每日剂量的剂量反应效应。
口服糖皮质激素的累积剂量与高血压发病率的增加相关，这表明应密切监测常规接受这些药物治疗的患者的血压。鉴于糖皮质激素广泛应用，相关的健康负担可能很高。临床试验.gov，编号 NCT03760562。
