非常に高齢者の抗高血圧薬:ランダム化対照試験のサブグループメタ分析. インダナ・グループ (INDANA Group) のインダナ・グループ (INDANA Group) のインダナ・グループ (INDANA Group)
F Gueyffier1, C Bulpitt, J P Boissel
1Clinical Pharmacology Department, Claude Bernard University, Lyon Hospitals, France. fg@upcl.univ.lyon1.fr
Lancet (London, England)
|August 25, 1999
まとめ
80歳以上の患者における抗高血圧薬の治療は,脳卒中と心不全を著しく減少させましたが,心血管疾患による死亡の利点は示されませんでした. この年齢層における死亡率の利益に関する決定的な結論を出すには,さらなる研究が必要である.
科学分野:
- ゲロントロジーはゲロントロジーの学科です.
- 心血管医学は,心臓血管医学である.
- 臨床薬理学 臨床薬理学とは
背景:
- 抗高血圧薬の効用は,若年および高齢の成人に確立されています.
- 80歳以上の個体における高血圧治療の有効性は依然として不確実である.
研究 の 目的:
- 80歳以上の患者の抗高血圧薬治療の臨床効果を評価する.
- この集団における脳卒中,死亡率,心血管疾患,心不全への影響を決定する.
主な方法:
- 80歳以上の参加者を含むランダム化対照試験のデータのメタ分析.
- 主要アウトカム:致死性および非致死性脳卒中.
- 二次的なアウトカム:全因死亡率,心血管疾患による死亡,主要心血管疾患,心不全.
主要な成果:
- 80歳以上の1670人の参加者の治療により,脳卒中の34%が予防されました.
- 主要な心血管疾患 (22%) と心不全 (39%) の有意な減少が観察されました.
- 心血管疾患による死亡の有意な効果は認められず,全因死亡率の6%の非有意な増加が認められた.
結論:
- 抗高血圧治療は,非常に高齢の患者の非致死性心血管疾患の治療に有益です.
- 死亡率に関する不確実な発見は,最終的な結論のために大規模な試験を必要とします.
- 現在の証拠は,高血圧治療を中止するための年齢制限を正当化するものではありません.
関連する概念動画
Antihypertensive Drugs: Direct Renin Inhibitors
The renin-angiotensin-aldosterone system (RAAS) is an intricate physiological pathway involving numerous enzymes and hormones, including renin, angiotensin-converting enzyme (ACE), angiotensin I and II, and aldosterone. Imbalances within this system increase the production of angiotensin II and aldosterone. Increased angiotensin II levels promote vasoconstriction and blood pressure elevation. Concurrently, higher aldosterone levels stimulate sodium and water reabsorption in the kidneys,...
Heart Failure Drugs: Inhibitors of Renin-Angiotensin System
The activation of the sympathetic nervous system and the renin-angiotensin-aldosterone system (RAAS) contributes to cardiac remodeling, and inhibiting the RAAS is a pharmacological target in heart failure management. As a result, neurohumoral modulation is a crucial treatment principle for managing heart failure. This approach involves using medications like ACE inhibitors (ACEIs), angiotensin receptor blockers (ARBs), β-blockers, mineralocorticoid receptor antagonists (MRAs), and neutral...
Drug Dosing: Geriatric Patients
Elderly individuals encompass a diverse population with varying degrees of age-related physiological changes. Defining the elderly presents challenges, as the geriatric population is often arbitrarily categorized as individuals older than 65. However, many individuals in this group lead active and healthy lives, with an increasing number surpassing 85 years and falling into the older elderly category. Physiological changes associated with aging impact performance capacity and homeostatic...
Pharmacokinetics in Geriatric Patients: Effect of Age on Drug Distribution
Drug distribution in the human body is influenced by several factors, including plasma protein concentration, body composition, blood flow, tissue-protein concentration, and tissue fluid pH. Among these, changes in plasma protein concentration and body composition due to aging significantly affect how drugs are distributed within the body. Specifically, aging is associated with a decrease in albumin levels by about 10% and an increase in α1-acid glycoprotein levels. These alterations are not...
Pharmacokinetics in Geriatric Patients: Effect of Age on Drug Metabolism
Geriatric patients show significant variation in how their bodies process medications, which can change how effective and safe treatments are. The liver is the primary organ where drug metabolism occurs, involving two main types of chemical reactions: phase I and II. Phase I metabolism is driven by the cytochrome P450 enzyme system, which includes key types such as CYP3A, CYP2D6, and CYP2C9. Research indicates that while aging doesn't notably alter the levels or activity of these enzymes, it...
Pharmacodynamics in Geriatric Patients: Effects of Age
Age-related pharmacokinetic changes are extensively documented, but understanding age-related pharmacodynamic alterations is relatively limited. This knowledge gap can be partly attributed to the complexity of developing appropriate measures of drug responses compared to bioanalytical methods for determining drug concentrations.Most information regarding age-related differences in human pharmacodynamics originates from cross-sectional studies. However, these studies assume that observed mean...

