軽度から中等度のアルツハイマー病を持つ高齢者における抗うつ薬の使用と起立性低血圧

Antidepressant Use and Orthostatic Hypotension in Older Adults Living with Mild-to-Moderate Alzheimer Disease.

• Adam H Dyer
• Claire Murphy
• Robert Briggs
• Brian Lawlor
• Sean P Kennelly
• Brian Lawlor
• Ricardo Segurado
• Sean Kennelly
• G M Marcel
• Robert Howard
• Florence Pasquier
• Anne Borjesson-Hanson
• Magda Tsolaki
• Ugo Lucca
• D William Molloy
• Robert Coen
• Matthias W Riepe
• Rose Anne Kenny
• Fiona Cregg
• Sarah O'Dwyer
• Cathal Walsh
• Jessica Adams
• Rita Banzi
• Laetitia Breuilh
• Leslie Daly
• Suzanne Hendrix
• Paul Aisen
• Siobhan Gaynor
• Ali Sheikhi
• Diana G Taekema
• Frans R Verhey
• Raffaello Nemni
• Flavio Nobili
• Massimo Franceschi
• Orazio Zanetti
• Anastasia Konsta
• Orologas Anastasios
• Styliani Nenopoulou
• Fani Tsolaki-Tagaraki
• Magdolna Pakaski
• Olivier Dereeper
• Olivier Senechal
• Agnès Devendeville
• Gauthier Calais
• Fiona Crawford
• Michael Mullan
• Pauline Aalten
• Maria A Berglund
• Jurgen A Claassen
• Rianne A De Heus
• Daan L K De Jong
• Olivier Godefroy
• Siobhan Hutchinson
• Aikaterini Ioannou
• Michael Jonsson
• Annette Kent
• Jurgen Kern
• Petros Nemtsas
• Minoa-Kalliopi Panidou
• Laila Abdullah
• Daniel Paris
• Angelina M Santoso
• Gerrita J van Spijker
• Martha Spiliotou
• Georgia Thomoglou
• Anders Wallin

抄録

目的:

抗うつ薬の使用はしばしば起立性低血圧（OH）の危険因子として報告されているが、この関係は特に脆弱なコホートを代表するかもしれない軽・中等度アルツハイマー病（AD）患者では検討されていない。

OBJECTIVES: Antidepressant use is often reported as a risk factor for Orthostatic Hypotension (OH), however this relationship has never been explored in those with mild/moderate Alzheimer Disease (AD), who may represent a particularly vulnerable cohort.

方法:

METHODS: We performed a cross-sectional analysis of baseline data from the NILVAD study. Participants with mild-moderate AD were recruited from 23 centres in 9 countries. Systolic and Diastolic Blood Pressure (SBP/DBP) was recorded in the seated position and after both 1 & 5 minutes of standing. OH was defined as a drop of ≥20 mmHg SBP/≥ 10 mmHg DBP. We examined the relationship between antidepressant use, orthostatic BP drop and the presence of OH, controlling for important covariates.

結果:

参加者509人（72.9±8.3歳、女性61.9％）のうち、5分の2（39.1％、199人/509人）は、定期的に抗うつ薬を処方されていた。抗うつ薬の使用は、5分後のSBPとDBPの低下が有意に大きいことと関連していた（β．SBPは1.83、0.16-3.50、P=0.03; β.1.13, 0.02-2.25, P<0.05）。)選択的セロトニン再取り込み阻害薬（SSRI）の使用は、OHの有意に高い可能性と関連していた（OR 2.0, 1.1-3.6, P=0.02）。両所見は、ロバスト共変量調整後も持続した。

RESULTS: Of 509 participants (72.9 ± 8.3 years, 61.9% female), two-fifths (39.1%; 199/509) were prescribed a regular antidepressant. Antidepressant use was associated with a significantly greater SBP and DBP drop at 5 minutes (β: 1.83, 0.16-3.50, P = 0.03 for SBP; β: 1.13, 0.02-2.25, P < 0.05 for DBP). Selective Serotonin Reuptake Inhibitor (SSRI) use was associated with a significantly greater likelihood of OH (OR 2.0, 1.1-3.6, P = 0.02). Both findings persisted following robust covariate adjustment.

結論:

ADを持つ高齢者では、抗うつ薬は5分後のSBP/DBP低下を有意に大きくすることと関連していた。特にSSRIの使用はOHの危険因子である可能性がある。このことは、この脆弱なコホートにおける転倒リスクを軽減するために、高齢の抗うつ薬使用者、特にAD患者をスクリーニングして起立性症状が継続していないかどうかを確認する必要性を強調している。この論文は著作権で保護されている。すべての権利を保有している。

CONCLUSIONS: In older adults with AD, antidepressants were associated with a significantly greater SBP/DBP drop at 5 minutes. SSRI use in particular may be a risk factor for OH. This emphasises the need to screen older antidepressant users, and particularly those with AD, for ongoing orthostatic symptoms in order to reduce the risk of falls in this vulnerable cohort. This article is protected by copyright. All rights reserved.

This article is protected by copyright. All rights reserved.