英國一線藥物治療高血壓的降壓效果因年齡和種族而有所不同
作者：
小柯機器人發布時間：2020/11/21 22:58:55
英國倫敦衛生和熱帶醫學院Sarah-Jo Sinnott團隊研究了根據年齡和種族分層採用一線藥物治療高血壓的降壓效果。2020年11月18日，該研究發表在《英國醫學雜誌》上。
為了研究根據英國（UK）高血壓臨床指南基於年齡和種族的治療建議，是否可在當前常規臨床護理中降低血壓，2007年1月1日至2017年12月31日，研究組在英國的初級保健部門進行了一項觀察性隊列研究。
研究組招募最新使用血管緊張素轉換酶抑制劑/血管緊張素受體阻滯劑（ACEI / ARB），鈣離子通道阻滯劑（CCB）和噻嗪類的參與者。主要觀察指標為從基線到第12、26和52周的隨訪，按年齡（<v≥55）和種族（黑人v非黑人）分層來比較ACEI / ARB與CCB新使用者的收縮壓變化。次要分析包括CCB和噻嗪類新使用者的比較。
隨訪一年，研究組共納入ACEI / ARB新使用者87440人，CCB新使用者67274人，噻嗪類藥物新使用者22040人。對於沒有糖尿病且年齡小於55歲的非黑人，在第12周時，使用CCB與使用ACEI / ARB相比，收縮壓降低更大，降低幅度差異為1.69 mmHg；55周歲及以上的人群降低幅度差異僅為0.40 mmHg。
在更詳細的年齡分層中，沒有糖尿病的非黑人亞組分析中，僅75歲及以上的人群使用CCB與ACEI / ARB相比，可使收縮壓下降更大。在沒有糖尿病的黑人人群中，使用CCB的收縮壓下降幅度比ACEI / ARB更大，差異為2.15 mmHg，而在沒有糖尿病的非黑人人群中，相應差異僅為0.98 mmHg。
研究結果表明，年齡在55歲以下和55歲以上的非糖尿病非黑人中，使用CCB和使用ACEI / ARB療效相差不大，血壓的降低與新使用ACEI / ARB有關。對於沒有糖尿病的黑人，與沒有糖尿病的非黑人相比，使用CCB的血壓降低幅度要比ACEI / ARB大得多。這表明當前用於一線抗高血壓治療的UK指南不一定能有效降壓。
附：英文原文
Title: First line drug treatment for hypertension and reductions in blood pressure according to age and ethnicity: cohort study in UK primary care
Author: Sarah-Jo Sinnott, Ian J Douglas, Liam Smeeth, Elizabeth Williamson, Laurie A Tomlinson
Issue&Volume: 2020/11/18
Abstract:
Objective To study whether treatment recommendations based on age and ethnicity according to United Kingdom (UK) clinical guidelines for hypertension translate to blood pressure reductions in current routine clinical care.
Design Observational cohort study.
Setting UK primary care, from 1 January 2007 to 31 December 2017.
Participants New users of angiotensin converting enzyme inhibitors/angiotensin receptor blockers (ACEI/ARB), calcium channel blockers (CCB), and thiazides.
Main outcome measures Change in systolic blood pressure in new users of ACEI/ARB versus CCB, stratified by age (< v ≥55) and ethnicity (black v non-black), from baseline to 12, 26, and 52 week follow-up. Secondary analyses included comparisons of new users of CCB with those of thiazides. A negative outcome (herpes zoster) was used to detect residual confounding and a series of positive outcomes (expected drug effects) was used to determine whether the study design could identify expected associations.
Results During one year of follow-up, 87440 new users of ACEI/ARB, 67274 new users of CCB, and 22040 new users of thiazides were included (median 4 (interquartile range 2-6) blood pressure measurements per user). For non-black people who did not have diabetes and who were younger than 55, CCB use was associated with a larger reduction in systolic blood pressure of 1.69 mm Hg (99% confidence interval 2.52 to 0.86) relative to ACEI/ARB use at 12 weeks, and a reduction of 0.40 mm Hg (0.98 to 0.18) in those aged 55 and older. In subgroup analyses using six finer age categories of non-black people who did not have diabetes, CCB use versus ACEI/ARB use was associated with a larger reduction in systolic blood pressure only in people aged 75 and older. Among people who did not have diabetes, systolic blood pressure decreased more with CCB use than with ACEI/ARB use in black people (reduction difference 2.15 mm Hg (6.17 to 1.87)); the corresponding reduction difference was 0.98 mm Hg (1.49 to 0.47) in non-black people.
Conclusions Similar reductions in blood pressure were found to be associated with new use of CCB as with new use of ACEI/ARB in non-black people who did not have diabetes, both in those who were aged younger than 55 and those aged 55 and older. For black people without diabetes, CCB new use was associated with numerically greater reductions in blood pressure than ACEI/ARB compared with non-black people without diabetes, but the confidence intervals were overlapping for the two groups. These results suggest that the current UK algorithmic approach to first line antihypertensive treatment might not lead to greater reductions in blood pressure. Specific indications could be considered in treatment recommendations.
DOI: 10.1136/bmj.m4080
Source: https://www.bmj.com/content/371/bmj.m4080