Rodríguez-Molinero Alejandro, Miñarro Antonio, Narvaiza Leire, Gálvez-Barrón César, Gonzalo León Natalia, Valldosera Esther, De Mingo Eva, Macho Oscar, Aivar David, Pinzón Efren, Alba Adilis, Passarelli Jorge, Stasi Nadia, Collado Isabel, Banegas José R
Consorci Sanitari De L'Alt Penedès I Garraf, Sant Pere De Ribes, Barcelona, Spain.
Department of Genetics, Microbiology and Statistics, Faculty of Biology, University of Barcelona, Barcelona, Spain.
Int J Hypertens. 2022 Oct 29;2022:4708259. doi: 10.1155/2022/4708259. eCollection 2022.
Low blood pressure (BP) has been proposed as a risk factor of death in elderly patients. However, this association could be partially accounted for by the deleterious effects of BP-lowering drugs. We analyzed whether these drugs are associated to an increased risk of death in elderly patients taking multiple potential confounders into account.
This is a prospective cohort study. Probabilistic sample of 772 community-dwelling patients aged >65 years living in Spain, who were appointed for an initial clinical visit and followed up through telephone calls 4, 6, 9, 12, and 60 months afterwards.
At baseline visit, BP was measured using standardized methods, and BP medications and risk factors of death in elderly patients (BMI, oxygen saturation, toxic habits, comorbidity, muscular strength, and functional and cognitive capacity) were collected. During the follow-up, the vital status of patients and the date of death were ascertained.
During a median 5-year follow-up, 226 all-cause deaths occurred among the 686 participants included in the analysis. In a Cox regression model that included all the BP drug classes, diuretics and nitrites were significantly associated with mortality ( < 0.005). Within diuretics, furosemide was found to be responsible for the association of the group. In multivariable Cox regression models adjusted for BP and the rest of the mortality risk factors, furosemide remained as the only BP drug that was independently associated with mortality (hazard ratio 2.34; < 0.01).
Furosemide was prospectively associated with increased mortality in older people. If confirmed, this drug should be taken into account by prescribers and considered a confounder in BP studies.
低血压已被认为是老年患者死亡的一个危险因素。然而，这种关联可能部分归因于降压药物的有害作用。我们分析了在考虑多种潜在混杂因素的情况下，这些药物是否与老年患者死亡风险增加相关。
这是一项前瞻性队列研究。对居住在西班牙的772名年龄大于65岁的社区居民进行概率抽样，这些患者被安排进行首次临床就诊，并在之后的4、6、9、12和60个月通过电话随访。
在基线访视时，使用标准化方法测量血压，并收集老年患者的降压药物和死亡风险因素（体重指数、血氧饱和度、不良习惯、合并症、肌肉力量以及功能和认知能力）。在随访期间，确定患者的生命状态和死亡日期。
在中位5年的随访期间，纳入分析的686名参与者中有226例全因死亡。在包含所有降压药物类别的Cox回归模型中，利尿剂和亚硝酸盐与死亡率显著相关（P<0.005）。在利尿剂中，发现速尿是该组关联的原因。在针对血压和其他死亡风险因素进行调整的多变量Cox回归模型中，速尿仍然是唯一与死亡率独立相关的降压药物（风险比2.34；P<0.01）。
速尿与老年人死亡率增加存在前瞻性关联。如果得到证实，开处方者应考虑这种药物，并在血压研究中视为一个混杂因素。
