Nielsen Sebastian K, Lamberts Morten, Nouhravesh Nina, Jensen Mads H, Strange Jarl E, Gislason Gunnar, Mcgettigan Patricia, Holt Anders
Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Gentofte Hospitalsvej 6, DK-2900 Hellerup, Denmark.
Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Gentofte Hospitalsvej 6, DK-2900 Hellerup, Denmark; Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, DK-2200 Copenhagen, Denmark.
Int J Cardiol. 2024 Aug 1;408:132137. doi: 10.1016/j.ijcard.2024.132137. Epub 2024 May 3.
Limited knowledge of antihypertensive treatment of the elderly potentially impedes effective strategies for hypertension management in this growing patient group. We aimed to investigate temporal trends for first-line drug choice for antihypertensive treatment and treatment continuity among patients ≥75 years from 2000 to 2021.
Using nationwide Danish registers, patients ≥75 years initiated for the first time on antihypertensive drugs: Angiotensin converting enzyme inhibitors (ACEi), angiotensin II receptor blockers (ARB), beta blockers (BB), calcium channel blockers (CCB), thiazides, or combinations, were identified. Patients with other indications than hypertension were excluded. Treatment continuity was described using claimed prescriptions the first 180 days following study entry.
From 2000 to 2021, 170,769 patients (median age 80 years [interquartile range:77-84], 60.3% female) were included. From 2000 to 2003 to 2015-2021 the proportion of first-line drug choice increased for ACEi (8.7% to 14.9%), ARB (4.1% to 23.9%), and CCB (10.7% to 27.6%), decreased for thiazides (60.6% to 15.9%) and remained stable for BB (12.9% to 14.1%) and combinations (2.9% to 3.6%). For 157,457 patients alive after 180 days, discontinuation was highest among patients initiated on thiazides (28.3%) whereas most patients continued the same single drug regimen if they started on ACEi (55.2%), ARB (65.0%), BB (57.2%) or CCB (59.3%).
From 2000 to 2021 thiazides have been replaced by ACEi, ARB and CCB. Thiazides had the lowest treatment continuity while ARB appeared preferred slightly over ACEi. Differences in adherence in relation to first-line drug choice may warrant scrutiny regarding recommendations for the elderly.
对老年患者降压治疗的了解有限，可能会阻碍针对这一不断增长的患者群体制定有效的高血压管理策略。我们旨在调查2000年至2021年期间75岁及以上患者抗高血压治疗一线药物选择的时间趋势以及治疗的持续性。
利用丹麦全国性登记册，确定首次开始使用抗高血压药物的75岁及以上患者：血管紧张素转换酶抑制剂（ACEi）、血管紧张素II受体阻滞剂（ARB）、β受体阻滞剂（BB）、钙通道阻滞剂（CCB）、噻嗪类药物或联合用药。排除患有高血压以外其他疾病的患者。使用研究入组后前180天的申领处方来描述治疗持续性。
2000年至2021年，共纳入170769例患者（中位年龄80岁[四分位间距：77 - 84岁]，女性占60.3%）。从2000年至2003年到2015年至2021年，ACEi（从8.7%增至14.9%）、ARB（从4.1%增至23.9%）和CCB（从10.7%增至27.6%）作为一线药物选择的比例增加，噻嗪类药物（从60.6%降至15.9%）的比例下降，BB（从12.9%降至14.1%）和联合用药（从2.9%降至3.6%）的比例保持稳定。对于180天后仍存活的157457例患者，噻嗪类药物起始治疗患者的停药率最高（28.3%），而如果起始使用ACEi（55.2%）、ARB（65.0%）、BB（57.2%）或CCB（59.3%），大多数患者会继续使用相同的单一药物治疗方案。
从2000年到2021年，噻嗪类药物已被ACEi、ARB和CCB所取代。噻嗪类药物的治疗持续性最低，而ARB似乎略优于ACEi。一线药物选择在依从性方面的差异可能需要对老年人的治疗建议进行审视。
