抗抑郁药和姿势低血压的风险:英国初级保健中的自我控制病例系列研究
Cini Bhanu1, Kate Walters2, Mine Orlu3
1Research Department of Primary Care and Population Health, University College London, London c.bhanu@ucl.ac.uk.
概括
60岁以上的成年人服用抗抑郁药物显著增加了体位低血压 (PH) 的风险,特别是SSRI,在第一个月内. 医疗保健提供者应该在给老年人开这些药物时监测PH.
科学领域:
- 老年医学 老年医学
- 药物监督 药物监督 药物监督
- 临床药理学 临床药理学
背景情况:
- 抗抑郁药与体位低血压 (PH) 有关,这在老年人中是一种严重的不良影响.
- 老年人的PH会导致跌倒,中风和认知能力下降.
- 临床试验往往不包括老年人,不关注不良影响.
研究的目的:
- 为了调查与60岁及以上的成年人服用抗抑郁药物相关的姿势性低血压 (PH) 的风险.
- 专注于英国人口中的初级保健数据.
主要方法:
- 使用例行收集的初级保健数据进行自我控制的病例系列设计.
- 在2000-2018年间,从IQVIA医学研究数据库 (IMRD) 分析了超过41,000名60岁以上的成年人.
- 在处方后的特定暴露期 (1-28天,29-56天,≥57天) 中检查的PH风险与未暴露期相比.
主要成果:
- 在使用前28天内,在所有抗抑郁药类药物中观察到PH的风险大幅增加.
- 选择性血红素再吸收抑制剂 (SSRI) 的风险最高 (IRR 4.22),其次是"其他抗抑郁药" (IRR 2.17) 和三环抗抑郁药 (TCA) (IRR 2.12).
- 对于所有类型的抗抑郁药,PH的风险在最初的28天后下降.
结论:
- 所有抗抑郁药,特别是SSRI,在治疗的最初一个月中,在老年人中构成显著的PH风险.
- 处方者应谨慎行事,并在开始抗抑郁药治疗时考虑对PH进行监测.
- 对这种风险的认识对于预防老年患者出现严重并发症至关重要.
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