Department of Internal Medicine, Erasmus MC University Medical Centre, Rotterdam, The Netherlands.
Cardiovascular Disease Program, Biomedicine Discovery Institute and Department of Physiology, Monash University, Melbourne, Australia.
Clin Transl Sci. 2021 Nov;14(6):2193-2199. doi: 10.1111/cts.13076. Epub 2021 Jun 21.
Previous studies showed that postmenopausal women are more likely to have poorly controlled hypertension than men of the same age. Whether this is caused by inadequate treatment or poor response to antihypertensive agents remains unknown. The aim of this study is to analyze treatment response to the most potent renin angiotensin aldosterone system (RAAS) inhibitor perindopril in different age categories in women and men. Individual patient data were used from the combined European Trial on Reduction of Cardiac Events With Perindopril (EUROPA), Perindopril Protection Against Recurrent Stroke Study (PROGRESS), and Action in Diabetes and Vascular disease: Preterax and Diamicron-MR Controlled Evaluation (ADVANCE) trials, which include patients with vascular disease (n = 29,463). We studied the relative and absolute changes in systolic blood pressure (SBP) and diastolic blood pressure (DBP) during a 4-week run-in phase in which all patients were treated with the perindopril-based treatment in different age categories. In total, 8366 women and 21,097 men were included in the analysis. Women greater than 65 years of age showed a significantly smaller blood pressure reduction after perindopril treatment (2.8 mmHg [95% confidence interval {CI} = 0.1-5.5] less reduction compared to women ≤45 years, p = 0.039). In men, the SBP reduction after perindopril in patients greater than 55-65 and greater than 65 years was lower compared to the age category less than or equal to 45 years (adjusted mean difference >55-65: 2.8 mmHg [95% CI = 1.8-3.7], p < 0.001, >65: 3.7 mmHg [95% CI = 2.7-4.7], p < 0.001). A trend of less blood pressure reduction was seen with ageing in both men and women (p < 0.001). To conclude, we observed that in both women and men the perindopril leads to less SBP reduction with increasing age, whereas the DBP reduction increases with age. More research is needed to determine whether it would be beneficial to use age-adjusted perindopril dosages.
先前的研究表明，绝经后女性比同年龄的男性更易出现高血压控制不佳的情况。这是由于治疗不充分还是对降压药物的反应不佳仍不清楚。本研究旨在分析在不同年龄组的女性和男性中，最有效的肾素-血管紧张素-醛固酮系统（RAAS）抑制剂培哚普利的治疗反应。个体患者数据来自联合欧洲培哚普利降低心脏事件研究（EUROPA）、培哚普利预防复发性卒中研究（PROGRESS）和糖尿病和血管疾病中的行动：培哚普利和二甲双胍缓释片控制评估（ADVANCE）试验，这些试验包括血管疾病患者（n=29463）。我们研究了在 4 周的导入期内，所有患者接受不同年龄组培哚普利治疗时收缩压（SBP）和舒张压（DBP）的相对和绝对变化。共有 8366 名女性和 21097 名男性纳入分析。年龄大于 65 岁的女性在接受培哚普利治疗后血压下降幅度明显较小（与年龄≤45 岁的女性相比，减少 2.8mmHg[95%置信区间{CI}：0.1-5.5]，p=0.039）。在男性中，年龄大于 55-65 岁和大于 65 岁的患者接受培哚普利治疗后的 SBP 下降幅度低于年龄≤45 岁的患者（调整后平均差异>55-65：2.8mmHg[95%CI：1.8-3.7]，p<0.001，>65：3.7mmHg[95%CI：2.7-4.7]，p<0.001）。随着年龄的增长，男性和女性的血压下降幅度均呈下降趋势（p<0.001）。总之，我们观察到，在女性和男性中，随着年龄的增长，培哚普利的 SBP 降低幅度减小，而 DBP 降低幅度随年龄增长而增加。需要进一步研究以确定是否使用年龄调整的培哚普利剂量会带来益处。
