抗高血圧薬のタイミングと心血管疾患と死亡:BedMed のランダム化臨床試験
Scott R Garrison1,2, Jeffrey A Bakal3,4, Michael R Kolber1,2
1Pragmatic Trials Collaborative, University of Alberta, Edmonton, Canada.
JAMA
|May 12, 2025
まとめ
寝る前に血圧薬を服用することは高血圧患者にとって安全ですが,朝の投与と比較して心血管疾患のリスクは低下しません. 治療のタイミングは,患者の好みに合わせて,最適な順番と結果を出す必要があります.
科学分野:
- 心臓病科
- 薬理学について
- 臨床試験
背景:
- 抗高血圧薬の投与の最適なタイミングは不明であり,主要な臨床試験の結果は一貫していない.
- 緑内障に関連した視力低下および低血圧/ 低血圧性イベントを含む,睡眠時の抗高血圧薬の使用の潜在的な有害性に関する懸念があります.
研究 の 目的:
- 主要な心血管疾患と死亡率に対する 抗高血圧薬の夜間投与と朝の投与の影響を調査する.
- 睡眠時の抗高血圧薬の安全性を評価する.
主な方法:
- カナダの5つの州で,高血圧の成人患者3357人を対象とした多センター,オープン,実用的なランダム化臨床試験.
- 参加者はランダムに割り当てられ,睡眠時間 (n=1677) または朝 (n=1680) に,全抗高血圧薬を1日1回服用した.
- すべての原因による死亡または主要な心血管疾患 (脳卒中,急性冠動脈症候群,心不全) の最初の発生までの時間を評価して,追跡期間は平均4. 6年であった.
主要な成果:
- 複合プライマリーアウトカムは,両方のグループで同様の割合で発生しました (寝る前のグループでは100患者年当たり2. 3対午前中のグループでは100患者年当たり2. 4; 調整された危険比率は0. 96; P=. 70).
- 主要アウトカムの個々の要素,全原因の入院/緊急診療,または転倒,骨折,新しいグラウコマ診断,または認知機能低下を含む安全性アウトカムにおいて,有意な差異は観察されなかった.
- 抗高血圧薬の睡眠時間投与は,この集団において安全であることが判明しました.
結論:
- 抗高血圧薬の夜間投与は,高血圧の初診患者では安全ですが,朝の投与と比較して心血管疾患のリスクを軽減しません.
- 抗高血圧薬の投与タイミングは,薬のリスクと効果を変化させるようには見えません.
- 治療のタイミングの決定は,患者の好みを優先して,従順性を高め,長期的な管理を改善する可能性がある.
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