减少养老院居民的抗高血压治疗
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
概括
在脆弱的老年人中减少抗高血压药物并没有降低死亡率. 这项研究发现,降级策略与老人院居民的常规护理之间死亡率没有显著差异.
科学领域:
- 老年学
- 心脏病学
- 临床试验
背景情况:
- 关于在虚弱的老年人中停止服用抗高血压药物的证据有限.
- 在这一群体中,抗高血压治疗是常见的,但降低的风险和益处尚不清楚.
研究的目的:
- 研究抗高血压药物治疗的逐步降低策略对脆弱的老年人所有原因的死亡率的影响.
- 在这个人群中比较降低抗高血压药物的安全性和有效性.
主要方法:
- 一个多中心,随机对照试验 (RETREAT-FRAIL) 涉及80岁及以上的养老院居民.
- 接受多种抗高血压药物,静脉压< 130 mm Hg 的参与者被随机分为降压策略或常规护理.
- 主要终点是全因死亡率,次要终点包括药物数量和血压变化长达4年.
主要成果:
- 1048名患者被随机分组. 降压组使用的抗高血压药物较少 (1. 5 vs 2. 0),并且静脉压下降较大 (4. 1 mm Hg 的差异).
- 所有原因的死亡率在各组之间是相似的 (61. 7% 降级 vs 60. 2% 常规护理;调整后的危险比率为1. 02).
- 两组之间没有明显的不良反应差异.
结论:
- 与常规治疗相比,降级抗高血压策略没有降低所有原因的死亡率.
- 这些发现表明,减少这种脆弱人群的抗高血压药物并不能改善生存结果.
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