Chuang Cheng-Hsun, Yang Shun-Fa, Liao Pei-Lun, Huang Jing-Yang, Chan Man-Yee, Yeh Chao-Bin
Institute of Medicine, Chung Shan Medical University, Taichung 402, Taiwan.
Department of Emergency Medicine, School of Medicine, Chung Shan Medical University, Taichung 402, Taiwan.
J Clin Med. 2022 Jun 9;11(12):3304. doi: 10.3390/jcm11123304.
Thiazide diuretics have long been widely used as antihypertensive agents. In addition to reducing blood pressure, thiazides also control calcium homeostasis and increase bone density. We hypothesized that the use of thiazides in patients with hypertension would reduce overall fracture risk. We used the Taiwan National Health Insurance Research Database to find patients with a hypertension diagnosis who accepted antihypertensive treatment from 2000 to 2017. The patients were further classified into thiazide users and nonthiazide users. Multivariable Cox regression analysis and Kaplan-Meier survival analysis were performed to estimate the adjusted hazard ratios (aHRs) and cumulative probability of fractures. After 1:1 propensity score matching by sex, age, urbanization level of place of residence, income, comorbidities, and medications, there were 18,483 paired thiazide users and non-users, respectively. The incidence densities of fractures (per 1000 person-months) were 1.82 (95% CI: 1.76-1.89) and 1.99 (95% CI: 1.92-2.06) in the thiazide and nonthiazide groups, respectively. The results indicated a lower hazard ratio for fractures in thiazide users (aHR = 0.93, 95% CI: 0.88-0.98). Kaplan-Meier survival analysis revealed a significantly lower cumulative incidence of fractures in the thiazide group (log-rank test; = 0.0012). In conclusion, our results reveal that thiazide use can reduce fracture risk. When antihypertensive agents are being considered, thiazide may be a better choice if the patient is at heightened risk of fracture.
噻嗪类利尿剂长期以来一直被广泛用作抗高血压药物。除了降低血压外，噻嗪类药物还能控制钙稳态并增加骨密度。我们假设，在高血压患者中使用噻嗪类药物会降低总体骨折风险。我们利用台湾国民健康保险研究数据库，找出2000年至2017年期间接受抗高血压治疗的高血压患者。这些患者进一步分为噻嗪类药物使用者和非噻嗪类药物使用者。进行多变量Cox回归分析和Kaplan-Meier生存分析，以估计调整后的风险比（aHRs）和骨折的累积概率。在按性别、年龄、居住地区城市化水平、收入、合并症和药物进行1:1倾向评分匹配后，分别有18483对噻嗪类药物使用者和非使用者。噻嗪类药物组和非噻嗪类药物组的骨折发病率密度（每1000人月）分别为1.82（95%CI：1.76-1.89）和1.99（95%CI：1.92-2.06）。结果表明，噻嗪类药物使用者骨折的风险比更低（aHR = 0.93，95%CI：0.88-0.98）。Kaplan-Meier生存分析显示，噻嗪类药物组的骨折累积发病率显著更低（对数秩检验；P = 0.0012）。总之，我们的结果表明，使用噻嗪类药物可以降低骨折风险。在考虑使用抗高血压药物时，如果患者骨折风险较高，噻嗪类药物可能是更好的选择。
