| 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. |
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