Psaty B M, Savage P J, Tell G S, Polak J F, Hirsch C H, Gardin J M, McDonald R H
Department of Medicine, University of Washington, Seattle.
JAMA. 1993 Oct 20;270(15):1837-41.
To estimate the incidence of newly treated hypertension and to describe the patterns of antihypertensive medication use among those aged 65 years and older.
Medicare eligibility lists from four US communities (Forsyth County, North Carolina; Washington County, Maryland; Sacramento County, California; and Pittsburgh, Pa) were used to obtain a representative sample of 5201 community-dwelling elderly for the Cardiovascular Health Study, a prospective cohort study of risk factors for coronary heart disease and stroke. Participants were examined at baseline and again 1 year later. The two examinations included standardized questionnaires, blood pressure measurements, and the assessment of medication use by medication inventory. In this cohort analysis, we excluded 231 subjects (4.4%) who did not return for follow-up, 69 (1.3%) who had missing data for medications, and another 495 (9.5%) who were taking "antihypertensive" medications for an indication other than high blood pressure.
None.
Among the 4406 participants, 1613 used antihypertensive medications at both visits. Between the two visits, 144 started and 115 stopped antihypertensive therapy. Among nonusers at baseline, the annual incidence of newly treated hypertension was 5.2% in women and 5.6% in men. Due to the number of participants who stopped therapy, the overall prevalence of antihypertensive treatment increased only slightly, from 40.7% to 41.1% in women and from 37.1% to 38.2% in men, during 1 year of follow-up. After adjustment for age, systolic blood pressure, number of antihypertensive drugs, diabetes, and cardiovascular disease, the newly treated hypertensives were about half as likely as the previously treated hypertensives to receive diuretics (odds ratio [OR], 0.59; P = .008) or beta-blockers (OR, 0.52; P = .01); and they were about twice as likely to receive calcium channel blockers (OR, 1.88; P < .004) or angiotensin converting enzyme inhibitors (OR, 2.40; P < .001). A similar pattern of within-person changes over time was apparent among the continuous users.
Between June 1990 and June 1991, physicians were increasingly prescribing angiotensin converting enzyme inhibitors and calcium channel blockers in place of diuretics and beta-blockers for the treatment of hypertension in elderly patients, especially for those just starting therapy.
评估新接受治疗的高血压发病率，并描述65岁及以上人群中抗高血压药物的使用模式。
利用来自美国四个社区（北卡罗来纳州福赛斯县、马里兰州华盛顿县、加利福尼亚州萨克拉门托县和宾夕法尼亚州匹兹堡）的医疗保险资格名单，为心血管健康研究选取了5201名社区居住老年人的代表性样本，该研究是一项关于冠心病和中风危险因素的前瞻性队列研究。参与者在基线时接受检查，1年后再次检查。两次检查包括标准化问卷、血压测量以及通过药物清单评估药物使用情况。在这项队列分析中，我们排除了231名（4.4%）未返回接受随访者、69名（1.3%）药物数据缺失者以及另外四百九十五名（9.5%）因非高血压指征而服用“抗高血压”药物者。
无。
在4406名参与者中，1613人在两次就诊时均使用抗高血压药物。两次就诊之间，144人开始抗高血压治疗，115人停止治疗。在基线时未使用者中，新接受治疗的高血压年发病率在女性中为5.2%，在男性中为5.6%。由于停止治疗的参与者数量，在1年的随访期间，抗高血压治疗的总体患病率仅略有增加，女性从40.7%增至41.1%，男性从37.1%增至38.2%。在对年龄、收缩压、抗高血压药物数量、糖尿病和心血管疾病进行调整后，新接受治疗的高血压患者接受利尿剂（比值比[OR]，0.59；P = 0.008）或β受体阻滞剂（OR，0.52；P = 0.01）治疗的可能性约为先前接受治疗的高血压患者的一半；而他们接受钙通道阻滞剂（OR，1.88；P < 0.004）或血管紧张素转换酶抑制剂（OR，2.40；P < 0.001）治疗的可能性约为先前接受治疗的高血压患者的两倍。在持续使用者中，随时间变化的个体内部变化模式相似。
在1990年6月至1991年6月期间，医生越来越多地开血管紧张素转换酶抑制剂和钙通道阻滞剂来替代利尿剂和β受体阻滞剂，用于治疗老年患者的高血压，尤其是刚开始治疗的患者。
