【作者】 赵霞；

【导师】 高静；

【作者基本信息】 成都中医药大学 ， 护理学， 2018， 硕士

【摘要】 研究目的采用Cochrane观察性研究的系统评价方法,对不同种类抗高血压药与老年人跌倒的风险关系进行系统评价,分析不同种类抗高血压药与老年人跌倒的风险关系,为老年人跌倒的药物危险因素研究提供循证证据,为观察性的循证护理研究提供方法学参考,为临床用药护理提供专业实证指导。研究方法本研究严格遵守Cochrane观察性研究的系统评价制作方法,按“PECOS”要素制定文献纳入排除标准以及详细的检索策略。通过检索国内外主要的10个数据库(CNKI、CBM、WANFANG、VIP、CENTRAL、Pubmed、EMbase、CINAHL、Wiley Online Library、Web of Science),收集有关不同种类抗高血压药与老年人跌倒相关的病例对照研究、队列研究或临床随机对照试验,检索日期为建库之日至2017年12月。三名研究者独立使用EndNote X7(文献管理软件)对检索的文献进行查重并剔除重复文献,再由三名研究者按纳入、排除标准独立筛选文献并进行交叉核对。对纳入文献的质量评价采用Cochrane协作网观察性研究方法学组推荐的NOS量表,自制数据提取表提取数据,最后采用Revman5.3软件对数据进行Meta分析。系统评价不同种类抗高血压药与老年人跌倒的风险关系。研究结果初步检索出22955篇文献,剔除重复文献1677篇、不符合纳入排除标准文献21066篇,初步纳入212篇,通过阅读全文,最终纳入21项研究,其中病例对照研究8项,队列研究13项,系统评价了利尿药、钙通道阻滞药、血管紧张素转换酶抑制剂、血管紧张素II受体拮抗剂、β受体阻滞剂、α受体阻滞剂与老年人跌倒的风险关系。具体结果如下:1.利尿药与老年人跌倒的风险关系(1)不同研究类型:(1)病例对照研究:未校正OR和校正OR合并结果均显示,利尿药与老年人跌倒的风险关系无统计学意义[未校正OR=0.83,95%CI(0.55,1.28),P=0.40][校正OR=1.00,95%CI(0.72,1.39),P=0.99]。(2)队列研究:未校正OR的合并结果显示,利尿药与老年人跌倒的风险关系有统计学意义[未校正OR=1.24,95%CI(1.06,1.45),P=0.006];校正OR的合并结果显示,利尿药与老年人跌倒的风险关系无统计学意义[校正OR=1.09,95%CI(0.95,1.25),P=0.24]。(2)不同研究场所:(1)养老院:病例对照研究和队列研究未校正OR合并结果均显示利尿药与老年人跌倒的风险关系无统计学意义[病例对照研究-未校正OR=0.60,95%CI(0.30,1.20),P=0.15],[队列研究-未校正OR=1.36,95%CI(0.94,1.98),P=0.10]。(2)医院:病例对照研究未校正OR和校正OR合并结果均显示利尿药与老年人跌倒的风险关系无统计学意义[未校正OR=0.75,95%CI(0.53,1.05),P=0.09],[校正OR=0.87,95%CI(0.64,1.20),P=0.40]。(3)社区:病例对照研究和队列研究未校正OR合并结果均显示利尿药与老年人跌倒的风险关系有统计学意义[病例对照研究-未校正OR=1.48,95%CI(1.37,1.60),P<0.001]、[队列研究-未校正OR=1.22,95%CI(1.02,1.45),P=0.03];病例对照研究校正结果表明利尿药与老年人跌倒的风险关系有统计学意义[病例对照研究-校正OR=1.25,95%CI(1.15,1.36),P<0.001];队列研究校正合并结果表明利尿药与老年人跌倒的风险关系无统计学意义[队列研究-校正OR=1.09,95%CI(0.95,1.25),P=0.24]。(3)不同种类利尿药:队列研究的校正OR合并结果表明,噻嗪类利尿药和袢利尿药与老年人跌倒的风险关系无统计学意义[噻嗪类利尿药校正OR=0.96,95%CI(0.85,1.08),P=0.50]、[袢利尿药校正OR=1.19,95%CI(0.95,1.50),P=0.13]。(4)是否全面控制混杂因素:校正OR的合并结果表明,利尿药与老年人跌倒的风险关系无统计学意义[校正OR=1.09,95%CI(0.95,1.24),P=0.21]。2.钙通道阻滞药与老年人跌倒的风险关系(1)不同研究类型:(1)病例对照研究:未校正OR的合并结果显示,CCB与老年人跌倒的风险关系有统计学意义[未校正OR=1.19,95%CI(1.14,1.24),P<0.05];校正OR的合并结果显示,CCB与老年人跌倒的风险关系无统计学意义[校正OR=1.01,95%CI(0.96,1.06),P=0.70]。(2)队列研究:未校正OR和校正OR合并结果均显示,CCB与老年人跌倒的风险关系无统计学意义[未校正OR=1.02,95%CI(0.80,1.32),P=0.86]、[校正OR=0.97,95%CI(0.80,1.17),P=0.74]。(2)不同研究场所:(1)养老院:病例对照研究和队列研究未校正OR值均表明CCB与老年人跌倒的风险关系无统计学意义[病例对照研究-未校正OR=1.40,95%CI(0.60,3.27),P=0.44][队列研究-未校正OR=2.18,95%CI(0.98,4.85),P=0.06]。(2)医院:病例对照研究未校正OR值及校正OR的合并结果均显示CCB与老年人跌倒的风险关系无统计学意义[未校正OR=1.33,95%CI(0.98,1.80),P=0.06][校正OR=1.00,95%CI(0.63,1.59),P=1.00]。(3)社区:病例对照研究未校正OR结果表明CCB与老年人跌倒的风险关系有统计学意义[病例对照研究-未校正OR=1.19,95%CI(1.14,1.24),P<0.001];队列研究未校正OR合并结果表明CCB与老年人跌倒的风险关系无统计学意义[队列研究-未校正OR=0.97,95%CI(0.75,1.24),P=0.78]。病例对照研究与队列研究的校正OR合并结果均表明CCB与老年人跌倒的风险关系无统计学意义[病例对照研究-校正OR=1.01,95%CI(0.96,1.06),P=0.70],[队列研究-校正OR=0.97,95%CI(0.80,1.17),P=0.74]。(3)是否全面控制混杂因素:仅1项研究全面控制了混杂因素,校正OR=1.20,95%CI(0.99,1.45),P>0.05,表明CCB与老年人跌倒的风险无统计学意义。3.血管紧张素转换酶抑制剂与老年人跌倒的风险关系(1)不同研究类型:(1)病例对照研究:未校正OR及校正OR的合并结果均显示,ACEI与老年人跌倒的风险关系有统计学意义[未校正OR=1.29,95%CI(1.24,1.36),P<0.05]、[校正OR=1.09,95%CI(1.04,1.14),P<0.05]。(2)队列研究:未校正OR及校正OR的合并结果均显示,ACEI与老年人跌倒的风险关系无统计学意义[未校正OR=1.03,95%CI(0.79,1.33),P=0.84]、[校正OR=0.98,95%CI(0.86,1.12),P=0.77]。(2)不同研究场所:(1)养老院:仅报道了未校正OR,病例对照研究结果表明ACEI与老年人跌倒的风险关系无统计学意义[未校正OR=1.00,95%CI(0.50,2.00),P=1.00],队列研究结果表明ACEI与老年人跌倒的风险关系有统计学意义[未校正OR=2.08,95%CI(1.18,3.67),P=0.01]。(2)医院:3项病例对照研究的未校正OR值及校正OR的合并结果均显示ACEI与老年人跌倒的风险关系无统计学意义[未校正OR=1.06,95%CI(0.72,1.56),P=0.77],[校正OR=1.10,95%CI(0.61,1.98),P=0.75]。(3)社区:病例对照研究未校正OR结果表明ACEI与老年人跌倒的风险关系有统计学意义[未校正OR=1.30,95%CI(1.24,1.36),P<0.001];队列研究未校正OR合并结果表明ACEI与老年人跌倒的风险关系无统计学意义[未校正OR=0.94,95%CI(0.75,1.18),P=0.57];病例对照研究校正OR结果表明ACEI与老年人跌倒的风险关系有统计学意义[校正OR=1.09,95%CI(1.04,1.14),P=0.0003];队列研究校正合并结果表明ACEI与老年人跌倒的风险关系无统计学意义[队列研究-校正OR=0.98,95%CI(0.86,1.12),P=0.77]。(3)是否全面控制混杂因素:仅1项研究全面控制了混杂因素,校正OR=1.07,95%CI(0.94,1.23),P>0.05,表明ACEI与老年人跌倒的风险关系无统计学意义。4.血管紧张素II受体拮抗剂与老年人跌倒的风险关系(1)不同研究类型:(1)病例对照研究:未校正OR及校正OR的合并结果均显示,ARB与老年人跌倒的风险关系无统计学意义[未校正OR=1.41,95%CI(0.78,2.55),P=0.26]、[校正OR=1.16,95%CI(0.68,2.00),P=0.59]。(2)队列研究:未校正OR及校正OR合并结果均显示,ARB与老年人跌倒的风险关系无统计学意义[未校正OR=0.99,95%CI(0.72,1.37),P=0.95]、[校正OR=0.99,95%CI(0.91,1.08),P=0.82]。(2)不同研究场所:(1)医院:仅1项病例对照研究报道了未校正和校正OR,未校正OR表明ARB与老年人跌倒的风险关系有统计学意义[未校正OR=2.1,95%CI(1.10,4.01),P<0.05],校正OR值表明ARB与老年人跌倒的风险关系无统计学意义[校正OR=1.7,95%CI(0.90,3.21),P>0.05]。(2)社区:病例对照研究未校正OR结果表明ARB与老年人跌倒的风险关系有统计学意义[未校正OR=1.12,95%CI(1.04,1.21),P=0.003];队列研究未校正OR合并结果表明ARB与老年人跌倒的风险关系无统计学意义[未校正OR=0.99,95%CI(0.72,1.37),P=0.95]。病例对照研究与队列研究的校正OR合并结果均表明ARB与老年人跌倒的风险关系无统计学意义[病例对照研究-校正OR=0.95,95%CI(0.87,1.04),P=0.25],[队列研究-校正OR=0.99,95%CI(0.91,1.08),P=0.82]。(3)是否全面控制混杂因素:仅1项研究全面控制了混杂因素,校正OR结果表明ARB与老年人跌倒的风险关系无统计学意义[校正OR=1.08,95%CI(0.90,1.30),P>0.05]。5.β受体阻滞剂与老年人跌倒的风险关系(1)不同研究类型:(1)病例对照研究:未校正OR的合并结果显示,β受体阻滞剂与老年人跌倒的风险关系有统计学意义[未校正OR=1.10,95%CI(1.05,1.15),P<0.0001],校正OR的合并结果显示,β受体阻滞剂与老年人跌倒的风险关系无统计学意义[校正OR=0.95,95%CI(0.90,1.00),P=0.06]。(2)队列研究:未校正OR及校正OR合并结果均显示,β受体阻滞剂与老年人跌倒的风险关系无统计学意义[未校正OR=1.08,95%CI(0.98,1.18),P=0.11]、[校正OR=1.03,95%CI(0.93,1.15),P=0.55]。(2)不同研究场所:(1)养老院:仅报道了未校正OR,病例对照研究和队列研究的未校正OR均显示β受体阻滞剂与老年人跌倒的风险关系无统计学意义[病例对照研究-未校正OR=1.20,95%CI(0.50,2.88),P=0.68][队列研究-未校正OR=0.75,95%CI(0.38,1.48),P=0.41]。(2)医院:病例对照研究的未校正OR和校正OR的合并结果均显示β受体阻滞剂与老年人跌倒的风险关系无统计学意义[未校正OR=1.15,95%CI(0.77,1.71),P=0.51][校正OR=0.98,95%CI(0.54,1.78),P=0.95]。(3)社区:病例对照研究未校正OR结果表明β受体阻滞剂与老年人跌倒的风险关系有统计学意义[未校正OR=1.10,95%CI(1.05,1.15),P<0.0001],队列研究未校正OR合并结果表明β受体阻滞剂与老年人跌倒的风险关系无统计学意义[未校正OR=1.09,95%CI(0.99,1.19),P=0.08]。病例对照研究与队列研究的校正OR合并结果均表明β受体阻滞剂与老年人跌倒的风险关系无统计学意义[病例对照研究-校正OR=0.95,95%CI(0.90,1.00),P=0.06][队列研究-校正OR=1.03,95%CI(0.93,1.15),P=0.55]。(3)是否全面控制混杂因素:仅1项研究全面控制了混杂因素,校正OR=1.22,95%CI(0.83,1.79),P>0.05,表明β受体阻滞剂与老年人跌倒的风险关系无统计学意义。6.α受体阻滞剂与老年人跌倒的风险关系(1)不同研究类型:(1)病例对照研究:未校正OR及校正OR合并结果均显示,α受体阻滞剂与老年人跌倒的风险关系无统计学意义[未校正OR=2.31,95%CI(0.97,5.48),P=0.06][校正OR=2.20,95%CI(0.82,5.90),P=0.12]。(2)队列研究:未校正OR及校正OR的合并结果均显示,α受体阻滞剂与老年人跌倒的风险关系无统计学意义[未校正OR=0.99,95%CI(0.70,1.40),P=0.96][校正OR=1.01,95%CI(0.75,1.37),P=0.95]。(2)不同研究场所:(1)医院:仅1报道了校正OR,结果显示α受体阻滞剂与老年人跌倒的风险关系无统计学意义[校正OR=2.20,95%CI(0.82,5.90),P>0.05]。(2)社区:校正OR合并结果显示α受体阻滞剂与老年人跌倒的风险关系无统计学意义[校正OR=1.01,95%CI(0.75,1.36),P=0.96]。研究结论本研究基于不同种类抗高血压药下的队列研究合并结果、不同研究场所的合并结果、是否控制混杂因素的合并结果,得出以下结论:利尿药、CCB、ACEI、ARB、β受体阻滞剂、α受体阻滞剂均不会增加老年人跌倒的风险。由于不同种类抗高血压药与老年人跌倒风险关系的研究数量较少,且各原始研究的校正因素不尽相同,可能存在残余混杂因素的影响,尚需未来高质量的前瞻性队列研究或临床随机对照试验进一步验证。此外,对于的不同剂量的抗高血压药与老年人跌倒的风险关系尚需未来研究进一步探讨。更多还原

【Abstract】 ObjectiveThe systematic evaluation method of Cochrane observational study was used to systematically evaluate the relationship between the different kinds of antihypertensive drugs and the fall risk of the elderly,to analyze the relationship between the different kinds of antihypertensive drugs and the fall of the elderly,and to provide evidence-based evidence for the study of the risk factors for the fall of the elderly,and for the observational evidence-based nursing research.To provide reference for providers and provide professional guidance for clinical medication nursing.MethodsThis study strictly adheres to the systematic evaluation and production method of Cochrane observational research,and incorporates the "PECOS" elements into the exclusion criteria and the detailed retrieval strategy.By retrieving 10 major databases at China and abroad(CNKI,CBM,WANFANG,VIP,CENTRAL,Pubmed,EMbase,CINAHL,Wiley Online Library,Web),a case-control study,a cohort study,or a clinical randomized controlled trial,related to the fall of the elderly,were collected.The date is until December 2017.Two researchers used the EndNote X7(document management software)to check the literature of the retrieval and eliminate the repeated documents.Then two researchers selected the documents independently and cross checked the documents according to the inclusion and exclusion criteria.The quality evaluation of the included literature was made by the NOS scale recommended by the Cochrane assistance network observational methodology group,and the self-made data extraction table was used to extract the data.Finally,the data was analyzed by the Revman5.3.software for the Meta analysis.Objective to systematically evaluate the relationship between different antihypertensive drugs and the risk of falls in the elderly.ResultsA total of 22955 papers were preliminarily retrieved,1677 repeated articles were excluded and 21066 articles were excluded because of the exclusion criteria,then 212 articles were included for carefully screening.Finally 21 studies were included after reading the full text,which including 8 case-control studies and 13 cohort studies.The relationship between diuretic drugs,calcium channel blockers,angiotensin converting enzyme inhibitors,angiotensin II receptor antagonists,beta blockers,alpha receptor retarder,and the risk of falling in the elderly was evaluated systematically.The concrete results are as follows: 1.The relationship between diuretic drugs and the risk of falling in the elderly(1)different study types:(1)case control study: unadjusted OR and adjusted OR combined results showed that the risk of diuretic drugs and elderly falls was not statistically significant [unadjusted OR= 0.83,95%CI(0.55,1.28),P=0.40] [adjusted OR=1.00,95%CI(0.72,1.39),P=0.99].(2)Cohort study: the combined results of unadjusted OR showed that the risk of diuretics and elderly falls was statistically significant [unadjusted OR=1.24,95%CI(1.06,1.45),P=0.006];the adjusted OR showed that there was not statistically significant relationship between diuretics and elderly falls[adjusted OR = 1.09,95%CI(0.95,1.25),P=0.24].(2)different research sites:(1)nursing homes: only unadjusted OR were reported.The combined results of case-control study and cohort study both showed that the risk of diuretics and elderly falls was not statistically significant[case control study-unadjusted OR= 0.60,95%CI(0.30,1.20),P=0.15],[cohort study-unadjusted OR= 1.36,95%CI(0.94,1.98),P=0.10].(2)hospital: the combined results of case-control study’s unadjusted and adjusted OR values showed that there were not statistically significant relationship between the risk of diuretics and elderly falls [unadjusted OR=0.75,95%CI(0.53,1.05),P=0.09],[adjusted OR= 0.87,95%CI(0.64,1.20),P=0.40].(3)community: The combined results of case-control study and cohort study’unadjusted OR both showed that the diuretics and elderly falls were not statistically significant[case control study-unadjusted OR=1.48,95%CI(1.37,1.60),P<0.001] [cohort study-unadjusted OR=1.22,95%CI(1.02,1.45),P=0.03];case control study adjusted OR combination results showed that the relationship between diuretics and elderly falls was statistically significant [case control study-adjusted OR= 1.25,95%CI(1.15,1.36),P<0.001];cohort study adjusted OR combination results showed that diuretics and elderly falls was not statistically significant [cohort study-adjusted OR=1.09,95%CI(0.95,1.25),P=0.24].(3)different types of diuretic drugs: Cohort studies’ adjusted OR combined results showed that there was no significant relationship between thiazide diuretic/loop diuretics and the risk of falling in the elderly [thiazide diuretic adjusted OR= 0.96,95%CI(0.85,1.08),P=0.50],[loop diuretics adjusted OR= 1.19,95%CI(0.95,1.50),P=0.13].(4)overall control of confounding factors: the results of the adjusted OR showed that the risk of diuretics and elderly falls was not statistically significant [adjusted OR= 1.09,95%CI(0.95,1.24),P=0.21].2.The relationship between calcium channel blockers and falls in the elderly.(1)different study types:(1)case control study: the combined results of unadjusted OR showed that the relationship between CCB and elderly falls was statistically significant [unadjusted OR= 1.19,95%CI(1.14,1.24),P < 0.05];the adjusted OR showed that there was no statistical significance in the relationship between CCB and elderly falls [adjusted OR= 1.01,95%CI(0.96,1.06),P=0.70].(2)Cohort study: the results of unadjusted OR and adjusted OR showed that there was no statistically significant relationship between the risk of CCB and elderly falls [unadjusted OR= 1.02,95%CI(0.80,1.32),P=0.86],[adjusted OR= 0.97,95%CI(0.80,1.17),P=0.74].(2)different research sites:(1)nursing homes: only unadjusted OR was reported.The combined results of case-control study and cohort study both showed that CCB and elderly falls was not statistically significant[case-control studyunadjusted OR= 1.40,95%CI(0.60,3.27),P=0.44] [cohort study-unadjusted OR= 2.18,95%CI(0.98,4.85),P=0.06].(2)hospital: the unadjusted OR and adjusted OR results of case-control study were showed that there was no significant difference between CCB and elderly falls [unadjusted OR= 1.33,95%CI(0.98,1.80),P=0.06] [adjusted OR= 1.00,95%CI(0.63,1.59),P=1.00].(3)community: the unadjusted OR of case-control study showed that there was significant difference between CCB and elderly falls [case-control study-unadjusted OR=1.19,95%CI(1.14,1.24),P<0.001];the unadjusted OR of cohort study showed that there was not significant difference between CCB and elderly falls [cohort study-unadjusted OR=0.97,95%CI(0.75,1.24),P=0.78];the adjusted OR of case-control study and cohort study were showed that there was not significant difference between CCB and elderly falls [case-control study-adjusted OR=1.01,95%CI(0.96,1.06),P=0.70],[cohort study-adjusted OR=0.97,95%CI(0.80,1.17),P=0.74].(3)overall control of confounding factors: only 1 studies have fully controlled the confounding factors and adjusted OR=1.20,95%CI(0.99,1.45),P>0.05,indicating that CCB and elderly falls was not statistically significant.3.The relationship between angiotensin converting enzyme inhibitors and falls in the elderly.(1)different study types:(1)case control study: the combination of unadjusted OR and corrected OR showed that ACEI and elderly falls was statistically significant [unadjusted OR= 1.29,95%CI(1.24,1.36),P < 0.05],[adjusted OR= 1.09,95%CI(1.04,1.14),P < 0.05].(2)Cohort study: the combined results of unadjusted OR and adjusted OR showed that there was no statistically significant relationship between ACEI and elderly falls [unadjusted OR= 1.03,95%CI(0.79,1.33),P=0.84],[adjusted OR= 0.98,95%CI(0.86,1.12),and P=0.77].(2)different research sites:(1)nursing homes: only unadjusted OR was reported.The result of case control study showed that ACEI and elderly falls was not statistically significant[unadjusted OR= 1.00,95%CI(0.50,2.00),P=1.00],the result of cohort study showed that ACEI and elderly falls was statistically significant [unadjusted OR= 2.08,95%CI(1.18,3.67),P=0.01].(2)hospital: The combined results of unadjusted OR and adjusted OR from 3 case-control studies were showed that there was no statistically significant relationship between ACEI and elderly falls [unadjusted OR= 1.06,95%CI(0.72,1.56),P=0.77] [adjusted OR= 1.10,95%CI(0.61,1.98),P=0.75].(3)community: The results of unadjusted OR from case-control study showed that ACEI and elderly falls was statistically significant [unadjusted OR=1.30,95%CI(1.24,1.36),P<0.001];The combined results of unadjusted OR from cohort studies showed that ACEI and elderly falls was not statistically significant [adjusted OR=0.94,95%CI(0.75,1.18),P=0.57].The results of adjusted OR from case-control study showed that ACEI and elderly falls was statistically significant [adjusted OR=1.09,95%CI(1.04,1.14),P=0.0003];the combined results of adjusted OR from cohort studies showed that ACEI and elderly falls was not statistically significant [adjusted OR=0.98,95%CI(0.86,1.12),P=0.77]。(3)overall control of confounding factors: only 1 studies have fully controlled the confounding factors and adjusted OR=1.07,95%CI(0.94,1.23),P > 0.05,indicating that there is no statistical significance in ACEI and elderly falls.4.The relationship between between angiotensin II receptor antagonists and falls in the elderly.(1)different study types:(1)case control study: the combination of unadjusted OR and adjusted OR showed that there was no statistically significant relationship between ARB and elderly falls [unadjusted OR= 1.41,95%CI(0.78,2.55),P=0.26],[adjusted OR= 1.16,95%CI(0.68,2.00),and P =0.59].(2)Cohort study: unadjusted OR and adjusted OR combined results showed that there was no statistically significant relationship between ARB and elderly falls [unadjusted OR= 0.99,95%CI(0.72,1.37),P=0.95],[adjusted OR= 0.99,95%CI(0.91,1.08),P=0.82].(2)different research sites:(1)hospital: only 1 case control study reported unadjusted OR and adjusted OR,the results of unadjusted OR showed that there was statistically significant relationship between ARB and elderly falls [unadjusted OR= 2.1,95%CI(1.10,4.01),P<0.05],the results of adjusted OR showed that there was not statistically significant relationship between ARB and elderly falls [adjusted OR= 1.7,95%CI(0.90,3.21),P>0.05].(2)community: The results of unadjusted OR from case-control study showed that there was statistically significant relationship between ARB and elderly falls [unadjusted OR=1.12,95%CI(1.04,1.21),P=0.003].The results of adjusted OR from cohort study showed that there was not statistically significant relationship between ARB and elderly falls [adjusted OR=0.99,95%CI(0.72,1.37),P=0.95].The adjusted OR combined results from case-control study and cohort study both showed that there were no statistically significant relationship between ARB and elderly falls [case control study-adjusted OR=0.95,95%CI(0.87,1.04),P=0.25] [cohort study-adjusted OR=0.99,95%CI(0.91,1.08),P=0.82]。(3)overall control of confounding factors: only 1 studies have fully controlled the confounding factors and adjusted OR= 1.08,95%CI(0.90,1.30),P>0.05,indicating that there is no statistical significance in ARB and elderly falls.5.The relationship between beta blockers and falls in the elderly.(1)different study types:(1)case control study: the combined results of unadjusted OR showed that the relationship between beta blocker and elderly falls was statistically significant [unadjusted OR= 1.10,95%CI(1.05,1.15),P < 0.0001].the combined results of adjusted OR showed that beta blocker and elderly falls was no statistical significance [adjusted OR= 0.95,95%CI(0.90,1),P=0.06].(2)Cohort study: the results of unadjusted OR and adjusted OR showed that there was no statistical significance in beta blocker and elderly falls [unadjusted OR= 1.08,95%CI(0.98,1.18),P=0.11],[adjusted OR= 1.03,95%CI(0.93,1.15),P=0.55].(2)different research sites:(1)nursing homes: only unadjusted OR was reported.The unadjusted OR of case control study and cohort study were both showed that there was no statistically significant relationship between beta blocker and elderly falls [case control study-unadjusted OR=1.20,95%CI(0.50,2.88),P=0.68] [cohort study-unadjusted OR=0.75,95%CI(0.38,1.48),P=0.41].(2)Hospital: The results of unadjusted OR and adjusted OR from case-control study both showed that the relationship between beta blocker and elderly falls was not statistically significant [unadjusted OR=1.15,95%CI(0.77,1.71),P=0.51] [adjusted OR= 0.98,95%CI(0.54,1.78),P=0.95].(3)Community: The case-control study’ unadjusted OR results showed that the relationship between beta blocker and elderly falls was statistically significant [unadjusted OR=1.10,95%CI(1.05,1.15),P<0.0001].The cohort study’ unadjusted OR results showed that the relationship between beta blocker and elderly falls was not statistically significant [unadjusted OR=1.09,95%CI(0.99,1.19),P=0.08]。The combined results of adjusted OR from case-control study and cohort studies were both showed that the relationship between beta blocker and elderly falls was not statistically significant[case-control study-adjusted OR=0.95,95%CI(0.90,1.00),P=0.06] [cohort study-adjusted OR=1.03,95%CI(0.93,1.15),P=0.55]。(3)overall control of confounding factors: only 1 studies have fully controlled the confounding factors and adjusted OR=1.22,95%CI(0.83,1.79),P > 0.05,indicating that there is no statistically significant relationship between beta blocker and elderly falls.6.The relationship between alpha blockers and falls in the elderly.(1)different study types:(1)case control study: the combined of unadjusted OR and adjusted OR results showed that alpha blocker and elderly falls was no statistical significance[unadjusted OR= 2.31,95%CI(0.97,5.48),P=0.06],[adjusted OR= 2.20,95%CI(0.82,5.90),P=0.12].(2)Cohort study: the combined results of unadjusted OR and adjusted OR showed that alpha blocker and elderly falls was not statistically significant [unadjusted OR= 0.99,95%CI(0.70,1.40),P=0.96],[adjusted OR= 1.01,95%CI(0.75,1.37),P=0.95].(2)different research sites:(1)hospital: only 1 reported adjusted OR.The results showed that there was no statistical significance in alpha blocker and elderly falls [adjusted OR= 2.20,95%CI(0.82,5.90),P>0.05].(2)Community: the results adjusted OR showed that there was no statistically significant relationship between alpha blocker and elderly falls [adjusted OR= 1.01,95%CI(0.75,1.36),P=0.96].ConclusionThis study is based on the results of the combined results of different types of antihypertensive drugs,the results of the combination of different research sites,and the control of the combination of mixed factors.The following conclusions are drawn: diuretics,CCB,ACEI,ARB,beta blockers and alpha receptor blockers will not increase the risk of falling in the elderly.There are few studies on the relationship between the different kinds of antihypertensive drugs and the fall risk of the elderly,and the correction factors of each study are not only the same,but there may be the effects of residual miscellaneous factors.The results still need to be verified by future high quality prospective cohort study or clinical randomized controlled trial.In addition,the relationship between the different dose of antihypertensive drugs and the risk of falls in the elderly needs further study.更多还原