血管紧张素转换酶抑制剂和血管紧张素受体阻滞剂与老年高血压患者抑郁风险的关系

T. V. van Sloten, P. Souverein, C. Stehouwer, J. Driessen
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引用次数: 4

摘要

背景:血管紧张素转换酶抑制剂(ACEIs)和血管紧张素受体阻滞剂(ARBs)是常用的降压药,可能对老年人抑郁症有保护作用,但在人类中的证据有限。目的:我们评估老年高血压患者的抑郁风险,比较ACE或ARB与噻嗪类利尿剂。噻嗪类利尿剂作为对照,因为这些药物与情绪障碍无关。方法:我们使用倾向评分匹配的新用户队列设计,并从临床实践研究数据链数据库中定期收集英国全科医生的数据。我们将12938对新使用acei / arb和噻嗪类利尿剂的高血压患者(平均年龄67.6岁;54.7%的女性)。随访时间开始于药物起始日,结束于治疗终止日加30天,或切换到比较物、研究事件的发生、死亡、患者转院日期或研究期结束。主要终点是治疗抑郁症和非致命性和致命性自残的复合终点。结果/结局:与噻嗪类利尿剂组相比,ACEIs/ arb的使用与主要结局的风险降低无关(风险比0.96(95%可信区间:0.79;1.15))。结果没有根据亲脂性、使用时间、平均日剂量或类别(ACEIs或arb)而有所不同。结论/解释:新使用acei或arb与高血压患者抑郁风险降低无关。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers and risk of depression among older people with hypertension
Background: Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs), commonly used antihypertensive drugs, may have a protective effect against depression in older individuals, but evidence in humans is limited. Aims: We evaluated the risk of depression, among older individuals with hypertension, comparing ACE or ARB initiators to thiazide(-like) diuretic initiators. Thiazide(-like) diuretics were used as control because these drugs are not associated with mood disorders. Methods: We used a propensity score-matched new user cohort design with routinely collected data from general practices in England from the Clinical Practice Research Datalink database. We matched 12,938 pairs of new users of ACEIs/ARBs and thiazide(-like) diuretics with hypertension (mean age 67.6 years; 54.7% women). Follow-up time started on the date of drug initiation and ended on the date of treatment discontinuation plus 30 days, or switch to a comparator, occurrence of a study event, death, date of patient’s transfer out of practice, or end of the study period. The primary outcome was a composite endpoint of treated depression and nonfatal and fatal self-harm. Results/outcomes: Compared to the thiazide(-like) diuretic group, ACEIs/ARBs use was not associated with a lower risk of the primary outcome (hazard ratio 0.96 (95% confidence interval: 0.79; 1.15)). Results did not differ according to lipophilicity, duration of use, and average daily dose, or class (ACEIs or ARBs). Conclusions/Interpretation: New use of ACEIs or ARBs is not associated with a lower risk of depression among individuals with hypertension.
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