The Risk of Hip Fracture After Initiating Antihypertensive Drugs in the Elderly

被引：131

作者：

Butt, Debra A. ^{[1
,2
,3
]}

Mamdani, Muhammad ^{[3
,4
]}

Austin, Peter C. ^{[5
,6
]}

Tu, Karen ^{[3
,5
]}

Gomes, Tara ^{[5
,7
]}

Glazier, Richard H. ^{[3
,5
,8
]}

机构：

[1] Ellesmere Hlth Care Ctr, Scarborough, ON M1H 2V6, Canada

[2] Scarborough Gen Hosp, Scarborough, ON, Canada

[3] Univ Toronto, St Michaels Hosp, Dept Family & Community Med, Toronto, ON M5B 1W8, Canada

[4] Univ Toronto, St Michaels Hosp, Appl Hlth Res Ctr, Li Ka Shing Knowledge Inst, Toronto, ON M5B 1W8, Canada

[5] Univ Toronto, St Michaels Hosp, Inst Clin Evaluat Sci, Toronto, ON M5B 1W8, Canada

[6] Univ Toronto, St Michaels Hosp, Dept Hlth Policy Management & Evaluat, Dalla Lana Sch Publ Hlth, Toronto, ON M5B 1W8, Canada

[7] Univ Toronto, St Michaels Hosp, Fac Pharm, Toronto, ON M5B 1W8, Canada

[8] Univ Toronto, St Michaels Hosp, Ctr Res Inner City Hlth, Toronto, ON M5B 1W8, Canada

来源：

ARCHIVES OF INTERNAL MEDICINE | 2012年 / 172卷 / 22期

基金：

加拿大健康研究院;

关键词：

ORTHOSTATIC HYPOTENSION; BLOOD-PRESSURE; MEDICATION USE; OLDER PERSONS; FALLS; HYPERTENSION; METAANALYSIS; INJURIES; POPULATION; PREVALENCE;

D O I：

10.1001/2013.jamainternmed.469

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Background: Initiating antihypertensive drugs in the elderly has been associated with an immediate increased risk of falls. However, it is unknown whether initiation of antihypertensive drugs (eg, thiazide diuretics, angiotensin II converting-enzyme inhibitors, angiotensin II receptor blockers, calcium channel blockers, or beta-adrenergic blockers) is associated with an immediate increased risk of hip fractures. Methods: A population-based, self-controlled case series design using health care administrative databases identifying patients initiating an antihypertensive drug in Ontario, Canada. A cohort of newly treated hypertensive elderly patients was linked to the occurrence of hip fractures from April 1, 2000, to March 31, 2009, to create exposed cases. The risk period was the first 45 days following antihypertensive therapy initiation with control periods before and after treatment in a 450-day observation period. The outcome measure was the first occurrence for a proximal femoral fracture during the risk period. The analysis determined the relative incidence (incidence rate ratio), defined as the hip fracture rate in the risk period compared with control periods. Results: Among the 301 591 newly treated hypertensive community-dwelling elderly patients, 1463 hip fractures were identified during the observation period. Hypertensive elderly persons who began receiving an antihypertensive drug had a 43% increased risk of having a hip fracture during the first 45 days following treatment initiation relative to the control periods (incidence rate ratio, 1.43; 95% CI, 1.19-1.72). Conclusions: Antihypertensive drugs were associated with an immediate increased hip fracture risk during the initiation of treatment in hypertensive community-dwelling elderly patients. Caution is advised when initiating antihypertensive drugs in the elderly. Arch Intern Med. 2012; 172(22): 1739-1744. Published online November 19, 2012. doi: 10.1001/2013.jamainternmed.469

引用

页码：1739 / 1744

页数：6

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