痴呆症患者高血压的治疗：一项多中心前瞻性观察队列研究,Journal of the American Medical Directors Association

当前位置： X-MOL 学术 › J. Am. Med. Dir. Assoc. › 论文详情

Our official English website, www.x-mol.net, welcomes your feedback! (Note: you will need to create a separate account there.)

痴呆症患者高血压的治疗：一项多中心前瞻性观察队列研究
Journal of the American Medical Directors Association ( IF 4.2 ) Pub Date : 2019-09-01 , DOI: 10.1016/j.jamda.2019.03.036
Tomas J Welsh ₁ , Adam L Gordon ₂ , John R F Gladman ₃

Affiliation

目的描述痴呆症患者高血压的治疗，并整理治疗期间不良健康事件的证据。设计一项多中心前瞻性观察队列研究。地点和参与者通过记忆诊所和全科医生从英国的 8 个地点招募有记录诊断为高血压和痴呆的人。方法该队列在 2013 年 7 月至 2014 年 10 月期间招募。参与者接受了面对面的血压 (BP)、日常生活活动、认知功能和药物使用的标准化评估。随访是通过每月电话采访进行 6 个月，以整理不良健康事件的数据。结果招募了 181 名参与者，随访了 177 名；126 (70%) 名女性，平均年龄为 82 [标准差 (SD) 6.3] 岁，简易精神状态检查得分中位数为 23 [四分位距 (IQR) 18-26]，平均血压为 141/78 (SD 22/12) mmHg。157 人（87%）开具了抗高血压药物。参与者被开出中位数为 1 (IQR 1-2) 的抗高血压药物。在 63% 的参与者中，血管紧张素转换酶抑制剂和/或血管紧张素受体阻滞剂是最常用的抗高血压药物。目标血压达到 58%（95% 置信区间 49%-64%）。抗高血压药数量的增加与收缩压或舒张压降低或达到目标血压的患者比例升高无关。参与者有 214 次跌倒，3 人发生骨折，3 人出现症状性心力衰竭，4 人发生脑血管事件，8 人死亡。结论/意义在这个轻度痴呆的人群中，参与者接受标准抗高血压药物治疗，比例与普通人群相似，达到目标血压的比例相似。不良健康事件的发生率高于抗高血压药物的随机对照试验，并引发了对支持痴呆症患者抗高血压治疗的假设的保留意见。这些发现可能有助于为临床决策提供信息。

"点击查看英文标题和摘要"

Treatment of Hypertension in People With Dementia: A Multicenter Prospective Observational Cohort Study

OBJECTIVES To describe the treatment of hypertension in people with dementia and collate evidence on adverse health events whilst on treatment. DESIGN A multicenter prospective observational cohort study. SETTING AND PARTICIPANTS People with documented diagnoses of hypertension and dementia were recruited through memory clinics and general practice from 8 sites in the United Kingdom. METHODS The cohort was recruited between July 2013 and October 2014. Participants underwent face-to-face, standardized assessment of blood pressure (BP), activities of daily living, cognitive function, and medication use. Follow-up was by monthly telephone interview for 6 months to collate data on adverse health events. RESULTS 181 participants were recruited and 177 followed up; 126 (70%) were female, mean age was 82 [standard deviation (SD) 6.3] years, median Mini-Mental State Examination score was 23 [interquartile range (IQR) 18-26] and mean BP was 141/78 (SD 22/12) mmHg. Antihypertensive drugs were prescribed in 157 (87%). Participants were prescribed a median of 1 (IQR 1-2) antihypertensive medication. Angiotensin-converting enzyme inhibitors and/or angiotensin receptor blockers were the most frequently prescribed antihypertensives in 63% of participants. Target BP was achieved in 58% (95% confidence interval 49%-64%). Increasing number of antihypertensives was not associated with lower systolic or diastolic BP, or with a higher proportion of patients attaining target BP. Participants had 214 falls, 3 had a fracture, 3 developed symptomatic heart failure, 4 had cerebrovascular events, and 8 died. CONCLUSIONS/IMPLICATIONS In this population of people with mild dementia, participants were treated with standard antihypertensive medications in a similar proportion to the general population, with a similar proportion achieving target BP. The rate of adverse health events was higher than in randomized controlled trials of antihypertensives and raises reservations about the assumptions underpinning antihypertensive treatment in people with dementia. These findings may help inform clinical decision making.

更新日期：2019-09-01

点击分享查看原文

点击收藏

公开下载

阅读更多本刊新发论文本刊介绍/投稿指南