VA Connecticut, West Haven, CT, United States of America; Yale School of Medicine, Department of Medicine, New Haven, CT, United States of America.
Yale School of Medicine, Department of Medicine, New Haven, CT, United States of America.
Exp Gerontol. 2020 Sep;138:111009. doi: 10.1016/j.exger.2020.111009. Epub 2020 Jun 25.
To further inform benefits and risks of medications on physical function in aging populations, we have evaluated the associations of antihypertensive (antiHTN) class and number used with skeletal muscle function, mobility, sedentary time, and symptoms in older persons.
Using baseline data from the Lifestyle Interventions and Independence in Elder (LIFE) study (N = 1567, mean age 78.9 years) and multivariable models, we evaluated cross-sectional associations of antiHTN class and number used with physical measures and symptom questionnaires. AntiHTN class included diuretics, angiotensin converting enzyme inhibitors (ACEi), angiotensin receptor blockers (ARB), calcium channel blockers (CCB), and beta blockers (BB). Physical measures included respiratory muscle weakness (maximal inspiratory pressure), grip weakness (dynamometer), impaired lower extremity proximal muscle strength (chair stands), impaired balance (three-stage test), slow gait (400 m walk), mobility impairment (Short Physical Performance Battery), and high sedentary time (accelerometry). Symptoms included dyspnea and fatigue. Covariates included clinical characteristics and non-antiHTNs.
Use of any antiHTN was highly prevalent (n = 1248 [79.6%]). In the antiHTN subgroup, each antiHTN class was well represented (ranging 36.6%-62.7%) and included use of three or more antiHTNs (32.0%). In adjusted models, the only statistically significant associations were use of BB and three or more antiHTNs with high sedentary time: odds ratios (95% confidence intervals) 1.44 (1.12, 1.85) and 1.52 (1.04, 2.23), respectively.
Use of BB and three or more antiHTNs yielded 44% and 52% increased odds of accelerometry-defined high sedentary time, respectively. Notably, high sedentary time is a risk factor for adverse health outcomes. Thus, future work should evaluate whether high sedentary time mitigates benefits or increases risks, regarding antiHTN use in aging populations.
为了进一步了解药物对老龄化人群身体功能的益处和风险，我们评估了抗高血压（antiHTN）类药物的使用种类和数量与老年人骨骼肌功能、移动能力、久坐时间和症状之间的关联。
使用生活方式干预和老年人独立（LIFE）研究的基线数据（N=1567，平均年龄 78.9 岁）和多变量模型，我们评估了抗高血压类药物的使用种类和数量与身体测量和症状问卷之间的横断面关联。抗高血压类药物包括利尿剂、血管紧张素转换酶抑制剂（ACEi）、血管紧张素受体阻滞剂（ARB）、钙通道阻滞剂（CCB）和β受体阻滞剂（BB）。身体测量包括呼吸肌无力（最大吸气压力）、握力减弱（测力计）、下肢近端肌肉力量减弱（椅子站立）、平衡受损（三级测试）、步态缓慢（400 米步行）、移动能力受损（简短身体性能测试）和久坐时间长（加速度计）。症状包括呼吸困难和疲劳。协变量包括临床特征和非抗高血压药物。
抗高血压药物的使用非常普遍（n=1248[79.6%]）。在抗高血压药物亚组中，每一种抗高血压药物类别都有很好的代表性（范围为 36.6%-62.7%），并包括使用三种或更多种抗高血压药物（32.0%）。在调整后的模型中，唯一具有统计学意义的关联是使用 BB 和三种或更多种抗高血压药物与高久坐时间之间的关联：比值比（95%置信区间）分别为 1.44（1.12，1.85）和 1.52（1.04，2.23）。
使用 BB 和三种或更多种抗高血压药物分别使加速度计定义的高久坐时间的几率增加了 44%和 52%。值得注意的是，高久坐时间是不良健康结果的一个危险因素。因此，未来的工作应该评估在老龄化人群中，高久坐时间是否会减轻抗高血压药物的益处或增加风险。
