| 摘要: | 目的：降血壓藥物目前已知和新生糖尿病有關，但是無論如何所有類別之降血壓藥物和新生糖尿病之間的關係仍然未完全明瞭。本研究之目的在調查所有類別之降血壓藥物和新生糖尿病之關連。
方法：這是一個從2002年1月至2006年12月的回溯前瞻性5年的研究。資料來自中區健保局門診高血壓病患的申報檔。本研究評估高血壓病患在追蹤5年後新生糖尿病的勝算比（OR），以追蹤5年沒有新生糖尿病病患為對照組。
結果：在所有23,280位病患之中，有4,183位新生糖尿病的產生。新生糖尿病勝算比危險較高的為單一使用利尿劑（勝算比1.10；95％信賴區間1.01-1.20），乙型阻斷劑（勝算比1.12；95％信賴區間1.04-1.21）和鈣離子阻斷劑（勝算比1.10；95％信賴區間1.02-1.18）。如果單一使用血管轉化?“磻蹌砥]勝算比0.92，95％信賴區間0.84-1.00）或甲型阻斷劑（勝算比0.88，95％信賴區間0.80-0.98）和沒有使用者比較，有較低勝算比危險性。血管轉化?§筐?器阻斷劑和血管擴張劑，則無關連。合併使用二種降血壓藥物之病人之中，產生新生糖尿病的勝算比危險性則以利尿劑加乙型阻斷劑（勝算比1.14， 95％信賴區間1.06-1.22），利尿劑加鈣離子阻斷劑（勝算比1.09；95％信賴區間1.01-1.17），和乙型阻斷劑加鈣離子阻斷劑（勝算比1.11；95％信賴區間1.03-1.19）比沒有使用者有較高的風險性。合併二或三種藥物治療的病患中，只要合併血管轉化?“磻蹌祟M甲型阻斷劑皆可降低新生糖尿病的危險性，而合併使用血管轉化?§筐?器阻斷劑和血管擴張劑，則較無影響。
結論：本研究建議高血壓患者，使用血管轉化?“磻蹌祟M甲型阻斷劑可降低新生糖尿病的危險性；而使用利尿劑、乙型阻斷劑和鈣離子阻斷劑則可增加新生糖尿病的危險性。
Aims：Antihypertensive drugs have been linked to new-onset diabetes (NOD); however, data on the effect of these drugs on the development of NOD in hypertensive patients has not been well determined. This study aimed to investigate the association between antihypertensive drugs and NOD.
Methods：This was a retrospective cohort study performed using data from claim forms provided to the central region branch of the Bureau of National Health Insurance in Taiwan from January 2002 to December 2006. Prescriptions for antihypertensive drugs before the index date were retrieved from a prescription database. We estimated the odds ratios (ORs) of NOD associated with antihypertensive drug use; nondiabetic subjects served as the reference group.
Results：A total of 4183 NOD cases were identified in 23280 hypertensive patients during the study period. The risk of NOD was higher among monotherapy users of diuretics (OR, 1.10; 95% confidence interval (CI), 1.01-1.20), beta-blockers (OR, 1.12; 95% CI, 1.04-1.21), and calcium channel blockers (OR, 1.10; 95% CI, 1.02-1.18) than among non-users. Patients who took angiotensin- converting enzyme (ACE) inhibitors (OR, 0.92; 95% CI, 0.84-1.00), or alpha-blockers (OR, 0.88; 95% CI, 0.80-0.98) were at a lower risk of developing NOD than non-users. Angiotensin receptor blockers, and vasodilators were not associated with risk of NOD.
The risk of NOD was higher among double combinations of diuretics plus beta-blockers (OR, 1.14; 95% confidence interval (CI), 1.06-1.22), diuretics plus calcium channel blockers (OR, 1.09; 95% CI, 1.01-1.17), and beta-blockers plus calcium channel blockers (OR, 1.11; 95% CI, 1.03-1.19) than among non-users. Patients who took angiotensin- converting enzyme (ACE) inhibitors, or alpha-blockers were at a lower risk of among double or three drug combinations developing NOD than non-users. Angiotensin receptor blockers, and vasodilators were not associated with risk of NOD among double or three drug combinations.
Conclusions：The results of this study suggest that hypertensive patients who take ACE inhibitors or alpha-blockers are at lower risk of NOD. Diuretics, beta-blockers, and calcium-blockers are associated with a significant increase in the risk of NOD. |
