Drugs Aging:超半数老年高血压患者使用潜在不恰当的降压药

2017-06-15 闫盈盈;石岩 环球医学

2017年6月,发表在《Drugs Aging》的一项由西班牙科学家进行的前瞻性、观察性研究,考察了老年高血压患者使用潜在不恰当的降压药的情况。

2017年6月,发表在《Drugs Aging》的一项由西班牙科学家进行的前瞻性、观察性研究,考察了老年高血压患者使用潜在不恰当的降压药的情况。

背景:既往对老年患者进行降压治疗的研究主要集中在血压控制、心血管风险或依从性方面,而对老年患者使用不恰当的降压药的数据却很少。

目的:本研究旨在评估对老年患者不恰当的降压处方。

方法:进行一项观察性、前瞻性、多中心研究,评估年龄≥75岁的动脉高血压患者(HTN)入院前一个月使用的潜在的不合理的降压药处方,用4种工具:比尔斯筛查工具、老年处方筛查工具(STOPP)、提示医生正确治疗的筛查工具(START)和弱势老人护理评估3筛查表(ACOVE-3)。评价初级治疗和医院电子病历记录的HTN诊断、降压治疗和血压情况。

结果:672名患者中,532名(中位年龄85岁,56%为女性)有高血压。21.6%接受降压单一疗法,4.7%未接受降压治疗,余下患者接受了联合降压疗法。最常开具处方的降压药是利尿药(53.5%)、血管紧张素转换酶抑制剂(ACEIs)(41%)、钙拮抗剂(32.2%)、血管紧张素受体阻滞剂(29.7%)和β受体阻滞剂(29.7%)。可以观察到51.3%的患者使用了潜在的不恰当的处方(27.8%处方过量和35%处方不足)。最常被不合理开具的药物是钙拮抗剂(处方过量)、ACEI和β受体阻滞剂(处方不足)。ACEI和β受体阻滞剂处方不足与心衰入院独立相关[β受体阻滞剂比值比(OR)0.53,95%置信区间(CI)0.39~0.71,P<0.001;ACEI OR 0.50,95% CI 0.36~0.70,P<0.001]。

结论:在超过半数接受降压治疗的患者中观察到到潜在的不恰当处方现象。处方不足比处方过量更常见。ACEI和β受体阻滞剂常处方不足,且与心衰入院相关。

原始出处:

Paola H. Ponte Márquez, Olga H. Torres, et al. Potentially Inappropriate Antihypertensive Prescriptions to Elderly Patients: Results of a Prospective, Observational Study. Drugs & Aging. June 2017, Volume 34, Issue 6, pp 453–466

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    2018-01-10 爆笑小医
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    2017-09-04 tsing_hit
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    2017-06-17 lou.minghong

    很多老人只吃药,不监测。

    0

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    2017-06-16 往日如昨

    学习了谢谢分享

    0

  8. [GetPortalCommentsPageByObjectIdResponse(id=1862250, encodeId=e346186225090, content=<a href='/topic/show?id=1f0e626267' target=_blank style='color:#2F92EE;'>#Drug#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=6262, encryptionId=1f0e626267, topicName=Drug)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=395f25, createdName=爆笑小医, createdTime=Wed Jan 10 20:37:00 CST 2018, time=2018-01-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1784752, encodeId=97d61e84752e9, content=<a href='/topic/show?id=e451626993' target=_blank style='color:#2F92EE;'>#drugs#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=46, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=6269, encryptionId=e451626993, topicName=drugs)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=dcaa509, createdName=tsing_hit, createdTime=Mon Sep 04 10:37:00 CST 2017, time=2017-09-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1291913, encodeId=212e1291913df, content=<a href='/topic/show?id=9d32981418b' target=_blank style='color:#2F92EE;'>#降压#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=98141, encryptionId=9d32981418b, topicName=降压)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8f14236, createdName=经常头晕, createdTime=Sat Jun 17 07:37:00 CST 2017, time=2017-06-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1448190, encodeId=923b1448190bf, content=<a href='/topic/show?id=5a9c102681f2' target=_blank style='color:#2F92EE;'>#高血压患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=102681, encryptionId=5a9c102681f2, topicName=高血压患者)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=b4665409655, createdName=维他命, createdTime=Sat Jun 17 07:37:00 CST 2017, time=2017-06-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1478904, encodeId=123214e89045c, content=<a href='/topic/show?id=5de08024597' target=_blank style='color:#2F92EE;'>#老年高血压#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=80245, encryptionId=5de08024597, topicName=老年高血压)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=87307462084, createdName=124985dbm08(暂无昵称), createdTime=Sat Jun 17 07:37:00 CST 2017, time=2017-06-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=211785, encodeId=72f6211e8510, content=很多老人只吃药,不监测。, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/oLAjfB7s1ib2JlGvwpAibiaovVhfA9DbO7X7JLGGjM4Cic6oMgxLdnuS9piaP9cnG2OwIbkzHvX0qzS1boibyYNqR5vHZu7HQs5EIB/0, createdBy=298d1398341, createdName=lou.minghong, createdTime=Sat Jun 17 07:14:01 CST 2017, time=2017-06-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=211559, encodeId=a814211559f9, content=学习了谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=60, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c0a61971598, createdName=往日如昨, createdTime=Fri Jun 16 14:24:00 CST 2017, time=2017-06-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=211238, encodeId=529521123841, content=学习了谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM4o2XVpJ6449yqDsjibydI5HnJ8MibGxNn4HZiaZib0bdfibbwoz3KQrIyN9AGxq36ZlZRNicYlPfOOWMtwgsajY6mGNFiaPclFdowjD0/0, createdBy=97bd1338592, createdName=清风拂面, createdTime=Thu Jun 15 21:44:25 CST 2017, time=2017-06-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=211226, encodeId=31d02112268e, content=学习了分享了, beContent=null, objectType=article, channel=null, level=null, likeNumber=66, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=387d1660055, createdName=dhzzm, createdTime=Thu Jun 15 20:48:12 CST 2017, time=2017-06-15, status=1, ipAttribution=)]
    2017-06-15 清风拂面

    学习了谢谢分享

    0

  9. [GetPortalCommentsPageByObjectIdResponse(id=1862250, encodeId=e346186225090, content=<a href='/topic/show?id=1f0e626267' target=_blank style='color:#2F92EE;'>#Drug#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=6262, encryptionId=1f0e626267, topicName=Drug)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=395f25, createdName=爆笑小医, createdTime=Wed Jan 10 20:37:00 CST 2018, time=2018-01-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1784752, encodeId=97d61e84752e9, content=<a href='/topic/show?id=e451626993' target=_blank style='color:#2F92EE;'>#drugs#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=46, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=6269, encryptionId=e451626993, topicName=drugs)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=dcaa509, createdName=tsing_hit, createdTime=Mon Sep 04 10:37:00 CST 2017, time=2017-09-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1291913, encodeId=212e1291913df, content=<a href='/topic/show?id=9d32981418b' target=_blank style='color:#2F92EE;'>#降压#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=98141, encryptionId=9d32981418b, topicName=降压)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8f14236, createdName=经常头晕, createdTime=Sat Jun 17 07:37:00 CST 2017, time=2017-06-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1448190, encodeId=923b1448190bf, content=<a href='/topic/show?id=5a9c102681f2' target=_blank style='color:#2F92EE;'>#高血压患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=102681, encryptionId=5a9c102681f2, topicName=高血压患者)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=b4665409655, createdName=维他命, createdTime=Sat Jun 17 07:37:00 CST 2017, time=2017-06-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1478904, encodeId=123214e89045c, content=<a href='/topic/show?id=5de08024597' target=_blank style='color:#2F92EE;'>#老年高血压#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=80245, encryptionId=5de08024597, topicName=老年高血压)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=87307462084, createdName=124985dbm08(暂无昵称), createdTime=Sat Jun 17 07:37:00 CST 2017, time=2017-06-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=211785, encodeId=72f6211e8510, content=很多老人只吃药,不监测。, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/oLAjfB7s1ib2JlGvwpAibiaovVhfA9DbO7X7JLGGjM4Cic6oMgxLdnuS9piaP9cnG2OwIbkzHvX0qzS1boibyYNqR5vHZu7HQs5EIB/0, createdBy=298d1398341, createdName=lou.minghong, createdTime=Sat Jun 17 07:14:01 CST 2017, time=2017-06-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=211559, encodeId=a814211559f9, content=学习了谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=60, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c0a61971598, createdName=往日如昨, createdTime=Fri Jun 16 14:24:00 CST 2017, time=2017-06-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=211238, encodeId=529521123841, content=学习了谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM4o2XVpJ6449yqDsjibydI5HnJ8MibGxNn4HZiaZib0bdfibbwoz3KQrIyN9AGxq36ZlZRNicYlPfOOWMtwgsajY6mGNFiaPclFdowjD0/0, createdBy=97bd1338592, createdName=清风拂面, createdTime=Thu Jun 15 21:44:25 CST 2017, time=2017-06-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=211226, encodeId=31d02112268e, content=学习了分享了, beContent=null, objectType=article, channel=null, level=null, likeNumber=66, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=387d1660055, createdName=dhzzm, createdTime=Thu Jun 15 20:48:12 CST 2017, time=2017-06-15, status=1, ipAttribution=)]
    2017-06-15 dhzzm

    学习了分享了

    0

相关威廉亚洲官网

全面收录!不同高血压人群,降压药选择有讲究

一、单纯收缩期或舒张期高血压1、单纯收缩期高血压:首选小剂量利尿剂单纯收缩期高血压一般多见于老年人,是心血管病独立的危险因素,脉压差过大,更易出现脑血管病及心肌梗死,首选小剂量利尿剂,如双氢克尿噻或寿比山等,注意低钾的不良反应,可同时选用保钾利尿剂螺内酯(安体舒通)或阿米洛利联合使用,如果效果不理想,可合并钙拮抗剂。钙拮抗剂通过阻断细胞电压依赖型钙通道,抑制钙进入细胞内,舒张血管平滑肌使外周屋

Hypertension:低剂量降血压药物组合效果理想,副作用更少

根据美国心脏协会发表的最新文章显示,四分之一剂量的降血压药物的组合降压效果是最好的,除此之外,还能降低单一高剂量所带来的副作用。

Hypertension:难治性高血压患者暂时停降压药安全吗?

总之,对高血压诊断评估时,停止服用抗高血压药物并不增加心血管事件的急性风险,但需要在一个具有适当的程序和监测安全的专业医院进行。

Hypertension:降压药物早期反应的异质性分析!

该研究结果表明对降压治疗的响应存在抑制性,并且氯噻酮相比于其他降压药物具有更有利的初始反应。

Br J Clin Pharmacol:哪些因素会影响患者使用降压药的依从性?

使用降压药的依从性差会影响治疗效果。2017年4月,发表在《Br J Clin Pharmacol》的一项研究显示,经历ADEs和对治疗不满意与较低的依从性相关。

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