Pahor M, Guralnik J M, Corti M C, Foley D J, Carbonin P, Havlik R J
Department of Internal Medicine and Geriatrics, Catholic University, Rome, Italy.
J Am Geriatr Soc. 1995 Nov;43(11):1191-7. doi: 10.1111/j.1532-5415.1995.tb07393.x.
To determine whether older persons with hypertension who use specific calcium antagonists and ACE inhibitors have a different risk of mortality than those using beta-blockers.
A prospective cohort study continuing from 1988 through 1992.
Three communities of the Established Populations for Epidemiologic Studies of the Elderly.
Hypertensive participants aged > or = 71 years (n = 906) who had no evidence of congestive heart failure and who were using either beta-blockers (n = 515), verapamil (n = 77), diltiazem (n = 92), nifedipine (n = 74), or ACE inhibitors (n = 148). Nifedipine was of the short acting variety.
The main outcome measure was all-cause mortality. Age, gender, smoking, HDL-cholesterol, blood pressure, intake of digoxin and diuretics, physical disability, self-perceived health, and comorbid conditions were examined as confounders.
During 3538 person-years of follow-up, 188 participants died (53 deaths per 1000 person-years). Compared with beta-blockers, after adjusting for age, gender, comorbid conditions and other health-related factors, the relative risks (95% confidence interval) for mortality associated with use of verapamil, diltiazem, nifedipine, and ACE inhibitors were 0.8 (0.4-1.4), 1.3 (0.8-2.1), 1.7 (1.1-2.7), and 0.9 (0.6-1.4), respectively. The results were unchanged after excluding participants with other potential contraindications to beta-blockers and after stratifying on coronary heart disease and use of diuretics. Higher doses of nifedipine were associated with higher mortality.
Compared with beta-blockers, use of short acting nifedipine was associated with decreased survival in older hypertensive persons. However, selective factors influencing the use of specific drugs in higher risk patients could not be completely discounted, and final conclusions will depend on clinical trials.
确定使用特定钙拮抗剂和血管紧张素转换酶抑制剂（ACE抑制剂）的老年高血压患者与使用β受体阻滞剂的患者相比，是否有不同的死亡风险。
一项从1988年持续至1992年的前瞻性队列研究。
老年流行病学研究的三个既定人群社区。
年龄≥71岁的高血压参与者（n = 906），他们没有充血性心力衰竭的证据，且正在使用β受体阻滞剂（n = 515）、维拉帕米（n = 77）、地尔硫卓（n = 92）、硝苯地平（n = 74）或ACE抑制剂（n = 148）。硝苯地平为短效品种。
主要结局指标是全因死亡率。将年龄、性别、吸烟、高密度脂蛋白胆固醇、血压、地高辛和利尿剂的摄入量、身体残疾、自我感知健康状况和合并症作为混杂因素进行研究。
在3538人年的随访期间，188名参与者死亡（每1000人年53例死亡）。与β受体阻滞剂相比，在调整年龄、性别、合并症和其他与健康相关的因素后，使用维拉帕米、地尔硫卓、硝苯地平和ACE抑制剂的死亡相对风险（95%置信区间）分别为0.8（0.4 - 1.4）、1.3（0.8 - 2.1）、1.7（1.1 - 2.7）和0.9（0.6 - 1.4）。在排除有β受体阻滞剂其他潜在禁忌证的参与者后，以及在按冠心病和利尿剂使用情况分层后，结果未变。更高剂量的硝苯地平与更高的死亡率相关。
与β受体阻滞剂相比，使用短效硝苯地平与老年高血压患者生存率降低有关。然而，影响高风险患者使用特定药物的选择因素不能完全排除，最终结论将取决于临床试验。
