ACEI和ARB降压药,是否能降低老年抑郁症发病风险?

2022-09-13 MedSci原创 MedSci原创 发表于上海

在这项基于人群的大型观察性研究中,与使用阴性对照(噻嗪类利尿剂)相比,使用 ACEI 或 ARB 与老年人患抑郁症的风险降低无关。

老年抑郁症是老年人常见精神健康问题之一,不仅损害老年患者的生活质量和社会功能,还会增加照料者的负担。据数据显示,全球三亿人抑郁症患者中,中老年人群发病率更高,其中,2% 65 岁或以上成年人患有重度抑郁症,并且其患病率随着年龄的增长而上升。

先前有研究显示,血管紧张素转化酶抑制剂(ACEI)和血管紧张素受体拮抗剂ARB)可直接或间接的对神经系统起到保护作用,而且对脑血管系统有益。然而,ACEIARB是否对抑郁症的发展具有保护作用仍然未知。

近期,发表在J Psychopharmacol期刊的一项研究,评估了老年高血压患者在初始使用ACEIARB类药物患抑郁症的风险。由于噻嗪类利尿剂情绪障碍无关,因此将其作为对照。

ACEIARB 类药物这个种类繁多,其中ACEI常用药有卡托普利、依那普利、赖诺普利及雷米普利等,而ARB常以「沙坦」命名,包括缬沙坦、氯沙坦、厄贝沙坦、替米沙坦、坎地沙坦、奥美沙坦和阿利沙坦。

其中,厄贝沙坦降压幅度较大,单药控制血压的达标率较高,吸收度高,药效持续时间长,在治疗高血压中占有重要地位。我国食药监局批准厄贝沙坦为高血压伴2糖尿病肾病的抗高血压药物,在国内的销量已经超过其他沙坦类,性价比最高。

研究人员使用了英国临床实践研究数据(CPRD-GOLD),该数据库与医院病历(HES)和国家统计局(ONS)的数据库相连。CPRD-GOLD包含来自英国的725家诊所的1100多万个人电子医疗数据,包括患者病史、实验室检查、处方、转诊、住院等。

在该研究中,研究人员纳入12938对符合条件的ACEI/ARB初始使用者和噻嗪类利尿剂初始使用者,患者平均年龄为67.6岁,54.7%为女性。随访时间从患者开始用药时开始,到停止治疗后,追加随访30天。

研究结果显示,ACEI/ARB 组的抑郁症发病率为 6.2/1000 人年(272 例),噻嗪类利尿剂组为 6.6/1000 人年(195 例抑郁症)。与对照组相比,初始使用ACEI ARB 与抑郁症的发病率和非致命性和致命性自伤风险降低无关。而且该结果并不因亲脂性、使用时间和日均剂量或类别(ACEIARB)而有所不同。

 

抑郁症和非致命性和致命性自残的发生率.

总之,在这项基于人群的大型观察性研究中,与使用阴性对照(噻嗪类利尿剂)相比,使用 ACEI ARB 与老年人患抑郁症的风险降低无关。

原始出处

van Sloten TT, Souverein PC, Stehouwer CD, Driessen JH. Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers and risk of depression among older people with hypertension. J Psychopharmacol. 2022 May;36(5):594-603. doi: 10.1177/02698811221082470. Epub 2022 Apr 7. PMID: 35388727; PMCID: PMC9112619.

 

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    2022-09-27 西瓜0628

    学习了

    0

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    2022-09-27 120d521dm50暂无昵称

    好文,学习了。

    0

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    2022-09-13 屋顶瞄爱赏月

    签到学习

    0

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    2022-09-13 医鸣惊人

    认真学习了

    0

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    2022-09-16 133e980am04暂无昵称

    0

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    2023-07-05 shanyongle
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    2022-09-14 ms2000000057946177

    学习

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