抗高血压药物类别与痴呆发生风险:一项基于多国人群的队列研究

IF 7.1 2区 医学 Q1 GERIATRICS & GERONTOLOGY
Edmund C L Cheung, Matthew Adesuyan, Máté Szilcz, Lisa M Kalisch Ellett, Sonia Shah, Yogini H Jani, Sara Hägg, Nicole Pratt, Kui Kai Lau, Hao Luo, Eric Yuk Fai Wan, Esther Wai Yin Chan, Ian C K Wong, Jacqueline K Yuen, Kai-Hang Yiu, Robert Howard, Ruth Brauer, Celine S L Chui
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引用次数: 0

摘要

血管紧张素转换酶抑制剂(ACEIs)和血管紧张素- ii受体阻滞剂(ARBs)是许多患者的一线降压药物,影响血管紧张素系统可能在痴呆风险中发挥作用。本研究旨在调查在一项大型跨国数据库研究中,与ACEI相比,暴露于不同抗高血压药物类别是否会影响痴呆和病理性痴呆亚型的风险。方法:采用香港、英国、瑞典和澳大利亚的电子健康数据库,开展了一项以人群为基础的多国队列研究。采用了一个共同的方案来协调研究设计。采用一种新的用户设计的活性比较器,比较不同降压药物类别之间的全因痴呆风险,以及阿尔茨海默病(AD)和血管性痴呆(VaD)的次要结局。采用处理加权逆概率的校正Cox比例风险模型在每个研究地点生成结果,并将结果汇总到荟萃分析中。结果四个数据库共纳入了1325563名个体,中位随访时间为5.6 - 8.4年。与ACEI相比,ARB起始治疗与全因痴呆(风险比:0.92,95%可信区间(CI): 0.89-0.94)和VaD(风险比0.87,95% CI 0.78-0.96)发生风险降低相关,但与AD无关。这是迄今为止进行的最大的跨国队列研究,调查了不同类别的降压药和痴呆发生的风险。当开始使用抗高血压药物时,医生和患者应在风险-收益评估中考虑与ACEI相比,ARB可降低全因痴呆和VaD的风险。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Antihypertensive drug classes and risk of incident dementia: a multinational population-based cohort study
Background Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin-II receptor blockers (ARBs) are first-line antihypertensive drugs for many patients, and influencing angiotensin systems may play a role in dementia risk. This study aimed to investigate whether exposure to different antihypertensive drug classes compared with ACEI affects the risk of dementia and pathological dementia subtypes in a large multinational database study. Methods This was a multinational population-based cohort study using electronic health databases in Hong Kong, the UK, Sweden and Australia. A common protocol was used to harmonise the study design. An active comparator, a new user design, was applied to compare the risk of all-cause dementia between different antihypertensive drug classes, with secondary outcomes of Alzheimer’s disease (AD) and vascular dementia (VaD). Adjusted Cox proportional hazards models with inverse probability of treatment weighting were used to generate results in each study site and were pooled in meta-analysis. Results One million nine hundred twenty-five thousand, five hundred sixty-three individuals were included across the four databases with a median follow-up ranging from 5.6 to 8.4 years. Compared to ACEI, initiation with ARB was associated with a reduced risk of incident all-cause dementia [hazard ratio (HR): 0.92, 95% confidence interval (CI): 0.89–0.94] and VaD (HR 0.87, 95% CI 0.78–0.96) but not AD. Conclusions This is the largest multinational cohort study conducted to date investigating different classes of antihypertensive drugs and the risk of incident dementia. When initiating antihypertensives, physicians and patients should consider the reduced risk of all-cause dementia and VaD with ARB compared with ACEI in their risk–benefit assessment.
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来源期刊
Age and ageing
Age and ageing 医学-老年医学
CiteScore
9.20
自引率
6.00%
发文量
796
审稿时长
4-8 weeks
期刊介绍: Age and Ageing is an international journal publishing refereed original articles and commissioned reviews on geriatric medicine and gerontology. Its range includes research on ageing and clinical, epidemiological, and psychological aspects of later life.
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