介護施設の住人の抗高血圧治療の減少
Athanase Benetos1,2, Sylvie Gautier1,2, Anne Freminet1
1Université de Lorraine, Centre Hospitalier Régional Universitaire (CHRU) Nancy, Pôle "Maladies du Vieillissement, Gérontologie et Soins Palliatifs," Nancy, France.
The New England journal of medicine
|August 29, 2025
まとめ
弱い高齢者の抗高血圧薬の投与を減らすことは死亡率を下げなかった. この研究では ステップダウン戦略と老人ホームの住人の通常のケアとの間で 死亡率の有意な差は見つかりませんでした
科学分野:
- ゲロントロジー
- 心臓病科
- 臨床試験
背景:
- 弱い高齢者の抗高血圧薬の中止に関する証拠は限られている.
- この集団では抗高血圧療法が一般的だが,そのリスクと利益は不明である.
研究 の 目的:
- 低血圧治療のステップダウン戦略が弱体高齢者の全因死亡率に及ぼす影響を調査する.
- 抗高血圧薬の安全性と有効性を,この集団における通常の治療と比較する.
主な方法:
- 80歳以上の介護施設の住人を対象とした多センター,ランダム化制御試験 (RETREAT-FRAIL).
- シストリック血圧<130mmHgの複数の抗高血圧薬を投与した被験者は,ステップダウン戦略または通常の治療にランダムに割り当てられました.
- 主要なエンドポイントは全因死亡率で,次要のエンドポイントは4年までの薬物数と血圧の変化でした.
主要な成果:
- 1048人の患者がランダムに分けられました. ステップダウングループは,抗高血圧剤を少なく (1. 5 対 2. 0) 服用し,シストリック血圧の低下が大きくなった (4. 1 mm Hg 差).
- すべての原因による死亡率は,グループ間で類似した (61. 7% ステップダウン vs 60. 2% 通常のケア;調整された危険比率,1. 02).
- 2つのグループ間で有害事象の有意な違いは認められなかった.
結論:
- 高血圧がコントロールされている弱体高齢者養護施設の住人の場合,ステップダウン抗高血圧療法により,通常の治療と比較して全因死亡率は低下しませんでした.
- この発見は,この脆弱な集団における抗高血圧薬の投与を減らしても生存率が向上しないことを示唆しています.
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