Discipline of General Practice, Adelaide Medical School, Faculty of Health and Medical Science, The University of Adelaide, South Australia, Australia.
Adelaide Rural Clinical School, Adelaide Medical School, Faculty of Health and Medical Science, The University of Adelaide, South Australia, Australia.
Brain Behav. 2023 May;13(5):e2943. doi: 10.1002/brb3.2943. Epub 2023 Apr 3.
There is mixed evidence about the impact of long-term management with hypnotic medications on blood pressure (BP).
To estimate the effect of short- and long-term management with benzodiazepine and z-drugs (BZD) on BP.
Open cohort study using deidentified electronic health records of 523,486 adult regular patients (42.3% males; mean age 59.0 ± 17.0 years) annually attending 402 Australian general practices between 2016 to 2018 (MedicineInsight database). Average treatment effects (ATE) of recorded incident BZD prescriptions in 2017 on systolic (SBP) and diastolic (DBP) BP after starting these prescriptions were computed using augmented inverse probability weighting (AIPW).
In 2017, 16,623 new cases of short-term management with BZD and 2532 cases of long-term management with BZD were identified (incidence 3.2% and 0.5%, respectively). The mean BP among those not treated with BZD (reference group) was 130.9/77.3 mmHg. Patients prescribed short-term BZD showed a slightly higher SBP (ATE 0.4; 95% CI 0.1, 0.7) and DBP (ATE 0.5; 95% CI 0.3, 0.7), while those on long-term BZD prescriptions showed lower SBP (ATE -1.1; 95% CI -2.0, -0.2), but no effect on DBP (ATE -0.1; 95% CI -0.8, 0.5). However, long-term BZD prescriptions showed a stronger BP-lowering effect among patients aged 65+ years (SBP ATE -2.5 [95% CI -3.8, -1.3]; DBP ATE -1.0 [95% CI -1.7, -0.2]), but almost no effect was observed among younger patients.
Long-term management with BZD had a BP-lowering effect among older patients. These findings add new evidence to current recommendations on limiting long-term BZD management in the elderly.
长期使用催眠药物治疗对血压（BP）的影响证据不一。
评估短期和长期使用苯二氮䓬类和 Z 类药物（BZD）治疗对 BP 的影响。
这是一项使用 2016 年至 2018 年期间在澳大利亚 402 家全科诊所就诊的 523486 名成年常规患者（42.3%为男性；平均年龄 59.0±17.0 岁）的匿名电子健康记录进行的开放性队列研究。使用增强逆概率加权（AIPW）计算 2017 年记录的新处方 BZD 对开始使用这些处方后收缩压（SBP）和舒张压（DBP）的平均治疗效果（ATE）。
2017 年，发现 16623 例新的短期 BZD 治疗病例和 2532 例长期 BZD 治疗病例（发生率分别为 3.2%和 0.5%）。未使用 BZD 治疗的患者（参照组）的平均 BP 为 130.9/77.3mmHg。短期 BZD 治疗患者的 SBP（ATE 0.4；95%CI 0.1，0.7）和 DBP（ATE 0.5；95%CI 0.3，0.7）略高，而长期 BZD 治疗患者的 SBP（ATE -1.1；95%CI -2.0，-0.2）较低，但 DBP 无影响（ATE -0.1；95%CI -0.8，0.5）。然而，长期 BZD 治疗对 65 岁以上患者的降压作用更强（SBP ATE -2.5[95%CI -3.8，-1.3]；DBP ATE -1.0[95%CI -1.7，-0.2]），但对年轻患者几乎没有影响。
长期使用 BZD 治疗对老年患者有降压作用。这些发现为当前限制老年人长期 BZD 治疗的建议提供了新的证据。
