老年糖尿病人群低血糖风险和抗高血压药物应用的队列研究(英文)  

Antihypertensives and risk of hypoglycemia in elderly hypertensive diabetic patients using antidiabetic drugs

作　　者：汤文璐[1] 王永铭[2] 杜文民 程能能[2] 陈斌艳[2] 

机构地区：[1]上海交通大学药学院药理实验室,上海200030 [2]复旦大学药学院药理学教研室,上海200032 [3]上海市药品不良反应检测中心,上海200040

出　　处：《中国临床药学杂志》2005年第4期214-219,共6页Chinese Journal of Clinical Pharmacy

摘　　要：目的了解抗高血压药物应用与服用抗糖尿病(DM)药物治疗的老年DM人群低血糖风险的方法.方法根据老年DM人群药物使用调查问卷,从我们建立的上海市社区老年DM人群用药监测系统中选取2001年6月至2002年6月服用抗DM药物的老年DM合并高血压者进行回顾性队列研究;以经过医院明确诊断的低血糖事件为观察终点;抗高血压药物相关的低血糖风险用经过校正的相对危险度(RR)表示;采用多个协变量的Poisson回归模型,在控制可能的混杂因素作用的基础上,对RR值进行估计.结果观察期1 a内确诊发生低血糖34例,同时服用抗高血压药物者低血糖发生率(2.76%)高于未服用抗高血压药物者(1.51%),但经可能的混杂因素校正后,两者差异无显著性[RR=1.98,95%可信区间(CI)0.59～6.59];复方降压片与其他抗高血压药物联合应用可显著增加同时服用磺酰脲类抗DM药物的老年患者低血糖的危险性(RR=6.87;95%CI,1.01～47.21);钙拮抗剂、利尿剂、选择性β受体阻滞剂、ACE抑制剂并不增加老年DM患者低血糖风险(P＞0.05);但其中ACE抑制剂单一用药在抗高血压药物中低血糖发生率最高(4.91%),对老年DM患者应慎用.结论在老年DM合并高血压的人群中,传统制剂复方降压片可以增加服用磺酰脲降糖药的老年患者的低血糖风险;对于老年DM患者抗高血压药物的选择极为重要,除考虑降压药物本身的疗效外,还应注意降压药对老年DM代谢控制的影响.AIM To determine the relationship between antihypertensives and the risk of hypoglycemia in elderly hypertensive diabetic patients using antidiabetics. METHODS We conducted a population-based, retrospective cohort study of 1 324 hypertensive patients with elderly diabetes mellitus (DM) who were selected from a database of the monitoring system for antidiabetic drugs in elderly diabetic population from five administrative areas in Shanghai and used the antidiabetics between 2001 June and 2002 June. The observational end point was hypoglycemia definitely diagnosed in hospitals. Descriptive statistical methods and Poisson regression model including multi-covariables were also used to identify the rates and the adjusted relative risk (RR) of hypoglycemia relating to antihypertensives. RESULTS We identified 34 persons with a first episode of hypoglycemia during the study period. The crude rate of hypoglycemia among antihypertensives users (2.76%) was higher than that in nonusers of antihypertensives (1.51%).While the increase had no satistically significant after controlling the confounding factors.With adjustment for a wide range of potential confounding factors, hypoglycaemia was significantly associated with current use of compound antihypertensive tablets and other antihypertensives in combination medications among the elderly hypertensive diabetic patients using sulphonylureas compared with antihypertensive nonusers (RR, 6.87; 95% confidence interral(CI), 1.01-47.21).Using the above group as the refevence,other classes of antihypertensive including cardioselective β-Blockers, diuretics, Zhenju antihypertensive tablets, calcium channel blockers (CCBs),angiotensin-converting enzyme (ACE) inhibitors had no higher risks of hypoglycemia(P>0.05), while among them ACE inhibitors in single medication would be cautious because of its highest incidence of hypoglycemia(4.91%).CONCLUSION Some traditional compound preparations like compound antihypertensive tablets could increase the risk of hypoglycemia among elderly hypert

关 键 词：老年糖尿病合并高血压 抗糖尿病药物 抗高血压药物 队列研究 POISSON回归 

分 类 号：R587.1[医药卫生—内分泌]