Pharmaco- and Device Epidemiology, Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, OX37LD, Oxford, UK.
Department of Medical Informatics, Erasmus Medical Center University, 40 3015 GD, Rotterdam, Netherlands.
Age Ageing. 2023 Sep 1;52(9). doi: 10.1093/ageing/afad177.
We assessed the risk of adverse events-severe acute kidney injury (AKI), falls and fractures-associated with use of antihypertensives in older patients with complex health needs (CHN).
UK primary care linked to inpatient and mortality records.
The source population comprised patients aged >65, with ≥1 year of registration and unexposed to antihypertensives in the year before study start. We identified three cohorts of patients with CHN, namely, unplanned hospitalisations, frailty (electronic frailty index deficit count ≥3) and polypharmacy (prescription of ≥10 medicines). Patients in any of these cohorts were included in the CHN cohort. We conducted self-controlled case series for each cohort and outcome (AKI, falls, fractures). Incidence rate ratios (IRRs) were estimated by dividing event rates (i) during overall antihypertensive exposed patient-time over unexposed patient-time; and (ii) in the first 30 days after treatment initiation over unexposed patient-time.
Among 42,483 patients in the CHN cohort, 7,240, 5,164 and 450 individuals had falls, fractures or AKI, respectively. We observed an increased risk for AKI associated with exposure to antihypertensives across all cohorts (CHN: IRR 2.36 [95% CI: 1.68-3.31]). In the 30 days post-antihypertensive treatment initiation, a 35-50% increased risk for falls was found across all cohorts and increased fracture risk in the frailty cohort (IRR 1.38 [1.03-1.84]). No increased risk for falls/fractures was associated with continuation of antihypertensive treatment or overall use.
Treatment with antihypertensives in older patients was associated with increased risk of AKI and transiently elevated risk of falls in the 30 days after starting antihypertensive therapy.
我们评估了在有复杂健康需求（CHN）的老年患者中使用抗高血压药物与不良事件（严重急性肾损伤（AKI）、跌倒和骨折）相关的风险。
英国初级保健与住院和死亡率记录相关联。
源人群包括年龄大于 65 岁、注册时间超过 1 年且在研究开始前 1 年内未使用抗高血压药物的患者。我们确定了有 CHN 的三个患者队列，即无计划住院、衰弱（电子衰弱指数缺陷计数≥3）和多种药物治疗（处方≥10 种药物）。任何这些队列中的患者均纳入 CHN 队列。我们为每个队列和结局（AKI、跌倒、骨折）进行了自身对照病例系列研究。通过将事件率（i）在整个抗高血压药物暴露患者时间与未暴露患者时间之间进行划分，以及（ii）在治疗开始后的前 30 天内与未暴露患者时间之间进行划分，来估计发病率比（IRR）。
在 CHN 队列的 42483 名患者中，分别有 7240、5164 和 450 人发生跌倒、骨折或 AKI。我们观察到在所有队列中，暴露于抗高血压药物与 AKI 风险增加相关（CHN：IRR 2.36 [95% CI：1.68-3.31]）。在抗高血压治疗开始后的 30 天内，所有队列中跌倒风险增加了 35-50%，而在衰弱队列中骨折风险增加（IRR 1.38 [1.03-1.84]）。继续使用抗高血压药物或总体使用与跌倒/骨折风险增加无关。
在老年患者中使用抗高血压药物与 AKI 风险增加以及开始抗高血压治疗后 30 天内跌倒风险暂时升高相关。
