Ambrož Martina, de Vries Sieta T, Hoogenberg Klaas, Denig Petra
Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands.
Department of Internal Medicine, Martini Hospital, Groningen, Netherlands.
Front Pharmacol. 2021 Sep 24;12:728911. doi: 10.3389/fphar.2021.728911. eCollection 2021.
Low systolic blood pressure (SBP) levels while being treated with antihypertensives may cause hypotension-related adverse events (hrAEs), especially in the elderly, women, and frail patients. We aimed to assess the association between the occurrence of hrAEs and low SBP levels, age, sex, and polypharmacy among patients with type 2 diabetes (T2D) treated with antihypertensives. In this cohort study, we used the Groningen Initiative to ANalyse Type 2 diabetes Treatment (GIANTT) database which includes patients managed for T2D in primary care from the north of the Netherlands. Patients treated with ≥1 antihypertensive drug and ≥1 SBP measurement between 2012 and 2014 were included. The outcome was the presence of an hrAE, i.e. postural hypotension, dizziness, weakness/tiredness, and syncope in 90 days before or after the lowest recorded SBP level. Age (≥70 vs. <70 years), sex (women vs. men), polypharmacy (5-9 drugs or ≥10 drugs vs. <5 drugs), and SBP level (<130 or ≥130 mmHg) were included as determinants. Logistic regression analyses were conducted for age, sex and polypharmacy, including the SBP level and their interaction, adjusted for confounders. Odds ratios (OR) with 95% confidence intervals (CI) are presented. We included 21,119 patients, 49% of which were ≥70 years old, 52% were women, 57% had polypharmacy, 61% had an SBP level <130 mmHg and 5.4% experienced an hrAE. Patients with an SBP level <130 mmHg had a significantly higher occurrence of hrAEs than patients with a higher SBP level (6.2 vs. 4.0%; ORs 1.41, 95%CI 1.14-1.75, 1.43, 95%CI 1.17-1.76 and 1.33, 95%CI 1.06-1.67 by age, sex, and polypharmacy, respectively). Older patients (OR 1.29, 95%CI 1.02-1.64) and patients with polypharmacy (OR 5-9 drugs 1.27, 95%CI 1.00-1.62; OR ≥10 drugs 2.37, 95% CI 1.67-3.37) were more likely to experience an hrAE. The association with sex and the interactions between the determinants and SBP level were not significant. Low SBP levels in patients with T2D treated with antihypertensives is associated with an increase in hrAEs. Older patients and those with polypharmacy are particularly at risk of hrAEs. Age, sex, and polypharmacy did not modify the risk of hrAEs associated with a low SBP level.
在接受抗高血压药物治疗时，收缩压（SBP）水平较低可能会导致与低血压相关的不良事件（hrAE），尤其是在老年人、女性和体弱患者中。我们旨在评估在接受抗高血压药物治疗的2型糖尿病（T2D）患者中，hrAE的发生与低SBP水平、年龄、性别和多种药物联合使用之间的关联。在这项队列研究中，我们使用了格罗宁根2型糖尿病治疗分析倡议（GIANTT）数据库，该数据库包括荷兰北部基层医疗中接受T2D管理的患者。纳入了在2012年至2014年间接受≥1种抗高血压药物治疗且有≥1次SBP测量值的患者。结局指标是在记录的最低SBP水平之前或之后90天内出现hrAE，即体位性低血压、头晕、虚弱/疲劳和晕厥。纳入年龄（≥70岁与<70岁）、性别（女性与男性）、多种药物联合使用（5 - 9种药物或≥10种药物与<5种药物）以及SBP水平（<130或≥130 mmHg）作为决定因素。对年龄、性别和多种药物联合使用进行逻辑回归分析，包括SBP水平及其相互作用，并对混杂因素进行了校正。呈现了具有95%置信区间（CI）的比值比（OR）。我们纳入了21119名患者，其中49%年龄≥70岁，52%为女性，57%使用多种药物联合治疗，61%的SBP水平<130 mmHg，5.4%经历了hrAE。SBP水平<130 mmHg的患者发生hrAE的几率显著高于SBP水平较高的患者（分别为6.2%与4.0%；按年龄、性别和多种药物联合使用情况计算的OR分别为1.41，95%CI 1.14 - 1.75、1.43，95%CI 1.17 - 1.76和1.33，95%CI 1.06 - 1.67）。老年患者（OR 1.29，95%CI 1.02 - 1.64）和使用多种药物联合治疗的患者（OR 5 - 9种药物为1.27，95%CI 1.00 - 1.62；OR≥10种药物为2.37，95%CI 1.67 - 3.37）更有可能经历hrAE。与性别的关联以及决定因素与SBP水平之间的相互作用不显著。接受抗高血压药物治疗的T2D患者中，低SBP水平与hrAE的增加相关。老年患者和使用多种药物联合治疗的患者尤其有发生hrAE的风险。年龄、性别和多种药物联合使用并未改变与低SBP水平相关的hrAE风险。
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