2025-08-29 東京科学大学
図1.本研究の概要図(オッズ:病気などある事象が「起こる確率/起こらない確率」の比率。オッズ比:ある事象のオッズを2つのグループ間で比較したもの。ここでは「薬が投与されたグループのオッズ/投与されていないグループのオッズ」の比率)
<関連情報>
- https://www.isct.ac.jp/ja/news/3ehz3t3cfsj2
- https://www.isct.ac.jp/plugins/cms/component_download_file.php?type=2&pageId=&contentsId=1&contentsDataId=2110&prevId=&key=aa5bcb68422c8bd048792d18ac6c1652.pdf
- https://academic.oup.com/ehjopen/article/5/4/oeaf096/8230180
非心臓手術における周術期降圧薬投与が機能低下と死亡率に及ぼす影響 Perioperative antihypertensive medications and effects on functional decline and mortality in non-cardiac surgery
Rena Suzukawa , Shintaro Mandai , Yuta Nakano , Shunsuke Inaba , Hisazumi Matsuki , Yutaro Mori , Fumiaki Ando , Takayasu Mori , Koichiro Susa , Soichiro Iimori …
European Heart Journal Open Published:11 August 2025
DOI:https://doi.org/10.1093/ehjopen/oeaf096
Abstract
Aims
The association between perioperative antihypertensive drugs and mortality as well as physical function in non-cardiac surgeries remains unclear. We aimed to clarify the association between six antihypertensive classes and postoperative outcomes.
Methods and results
This observational cohort study involved adults undergoing non-cardiac surgeries between 2014 and 2019 using an administrative claims database. We recruited 408 810 patients who continuously used any class of antihypertensive medication both pre- and postoperatively and 2 190 064 non-continuous users aged ≥50 years who underwent five different types of non-cardiac surgeries. The risk for overall death or functional decline, defined as a ≥20% decrease in the Barthel Index score during hospitalization, was determined using multivariable logistic regression models. All-cause deaths or functional decline occurred in 4228 (1.0%) users and 17 978 (0.8%) non-users or 20 625 (5.0%) users and 66 218 (3.0%) non-users, respectively. Among single-class users, angiotensin-converting enzyme inhibitors (ACEis) or angiotensin II receptor blockers (ARBs) showed a multivariable odds ratio (OR) of 0.74 [95% confidence interval (CI) 0.62–0.89 vs. thiazide/thiazide-like diuretics (TH)] for the composite of mortality and functional decline. Among recipients of two medication classes, calcium receptor blockers (CCBs)/ACEi or ARB usage was associated with the lowest risk for composite outcome (OR, 0.86; 95% CI, 0.81–0.91 vs. TH/CCBs). The combinations of the ≥3 classes, including TH/CCB/ACEi or ARB, displayed the lowest odds for the composite outcome. In orthopaedic surgery and gastrointestinal resection, ACEis or ARBs were associated with better survival and physical function.
Conclusion
Perioperative use of ACEis or ARBs is associated with favourable outcomes in non-cardiac surgeries.
