长期服用安定类药物对社区高血压患者临床事件的影响

Effect of Long-Term Application of Benzodiazepines on Major Clinical Events in Patients with Hypertension in Community

目的探讨长期服用安定类药物对高危和极高危高血压患者临床事件的影响。方法 2015年10月从上海市闵行区古美社区卫生服务中心的高血压数据库中筛选符合相关条件的高危及极高危老年高血压患者1 222例,根据服药情况分为安定组和非安定组。安定组为121例,其中男性66例,年龄为65~80岁(72.0±4.5岁)。非安定组为1 101例,其中男性600例,年龄为50~97岁(71.1±4.4)岁。安定组与非安定组其它指标比较,LDL-C:(3.02±0.82)mmol/L比(2.90±0.75)mmol/L,基线收缩压:(129.2±8.6)mmHg比(129.6±7.4)mmHg,基线值舒张压:(77.2±6.0)mmHg比(77.4±5.2)mmHg,糖尿病:31例比306例。(以上指标均P>0.05)。基线心血管事件:19例比109例,(P=0.049)。所有患者均根据目前指南严格控制血压。随访并记录患者第6、12、18个月的血压及相关临床事件。结果 3个时点的随访结果:(1)安定组比非安定组,第6个月的收缩压:(131.1±8.7)mmHg比(130.6±8.2)mmHg (P>0.05),舒张压(78.0±5.9)mmHg比(78.2±5.5)mmHg (P>0.05);第12个月的收缩压(131.0±8.4)mmHg比(130.5±9.3)mmHg(P>0.05),舒张压(78.2±6.0)mmHg比(78.7±7.4)mmHg (P>0.05);第18个月的收缩压:(129.5±7.9)mmHg比(129.6±8.8)mmHg (P>0.05);舒张压(77.3±5.8)mmHg比(77.4±6.4)mmHg (P>0.05)。(2)临床事件随访结果:第6个月总体重要临床事件,安定组比非安定组:1例比10例(P>0.05)。第12个月总体重要临床事件,安定组比非安定组:2例比18例(P>0.05)。第18个月总体重要临床事件,安定组比非安定组:6例比31例(P>0.05)。结论在高血压高危及极高危老年患者中,在严格控制血压的基础上,长期服用安定类药物未发现增加18个月内的总死亡、心血管事件的发生率。

Objective To explore the effect of long-term application of benzodiazepines on major clinical events in patients with hypertension in community.Methods 1222 elderly with hypertension of high risk and very high risk were screened out fromthe hypertension database of Gumei CommnunityHealth Center,Minhang district,Shanghai and divided into 2 groups according to their drug application:benzodiazepine group and non-benzodiazepine group;therewere 121 elderly in benzodiazepine group,66males and55females,aged from 65 to 80 years(72.0±4.5)while 1101elderly in non-benzodiazepine group,600males and 501 females,aged from50to97years(71.1±4.4);the comparison of other data between the 2 groups included LDL-C[(3.02±0.82)mmol/L vs(2.90±0.75)mmol/L],baseline systolic blood pressure(SBP)[(77.2±6.0)mmHg vs77.4±5.2)mmHg],baseline diastolic blood pressure(DBP)[(77.2±6.0)mmHg va(77.4±5.2)mmHg and cases with diabetes(31vs306)(All P>0.05)while the ratio of cardiovascular event occurrence was19vs109(P=0.049);antihypertensive therapy recommended by the latest guideline was applied to all the cases,and the blood pressure and related clinical events of the cases at the time point of the6th,the12th and the18th month after enrollment were followed up and recorded.Results The followup results of benzodiazepine group vs non-benzodiazepine group at the3time points were as follows:(1)SBP and DBP at the6th month:(131.1±8.7)mmHg vs(130.6±8.2)mmHg(P>0.05)and(78.0±5.9)mmHg vs(78.2±5.5)mmHg(P>0.05);SBP andDBP at the12thmonth:(131.0±8.4)mmHg vs(130.5±9.3)mmHg(P>0.05)and(78.2±6.0)mmHg vs(78.7±7.4)mmHg(P>0.05);SBP and DBP at the18th month:(129.5±7.9)mmHg vs(129.6±8.8)mmHg(P>0.05)and(77.3±5.8)mmHg vs(77.4±6.4)mmHg(P>0.05).(2)The occurrence of major clinical events in the6th month:1case vs10cases(P>0.05),in the 12 thmonth:2 cases vs18cases(P>0.05)and in the18thmonth:6 cases vs 31 cases(P>0.05).Conclusions Long-term application of benzodiazepine will not increase the total death rate and the occurrence of cardiovascular events within a period of18months in the elderly with hypertension of high and very high risk when the blood pressure is strictly controlled.