Abstract: Background　The relationship between antihypertensive drugs and the risk of falls in the elderly is controversial.As a common antihypertensive drug, beta-blocker has a unclear relationship with falls among the elderly.Objective　To systematically evaluate the association between beta-blocker use and falls in the elderly，so as to provide a basis for relevant clinical decision making.Methods　Data of cohort studies and case-control studies of beta-blocker use and falls in the elderly were collected by searching eight electronic databases： PubMed，EMBase，CENTRAL，CINAHL，CBM，CNKI，VIP and Wanfang Data Knowledge Service Platform from inception to November 2017.Two reviewers independently screened studies according to the inclusion and exclusion criteria，extracted data，and assessed methodological quality with the Newcastle-Ottawa Scale （NOS）．Then，data synthesis was performed using RevMan 5.3 software.Results　A total of 13 studies involving 72 539 patients were included （eight cohort studies and five case-control studies）．Meta-analysis of results from cohort studies with a crude OR showed that beta-blocker use did not increase the risk of falls in elderly patients 〔OR=1.07，95%CI（0.98，1.18），P=0.14〕.Moreover，beta-blocker use was still not associated with an increased risk of falls in elderly patients in those studies with an adjusted OR 〔adjusted OR=1.04，95%CI（0.93，1.15），P=0.50〕.Meta-analysis of results from case-control studies with a crude OR showed that beta-blocker use was associated with an increased risk of falls in elderly patients〔OR=1.10，95%CI（1.05，1.15），P<0.000 1〕，while those studies with an adjusted OR indicated that beta-blocker use was not associated with an increased risk of falls in elderly patients 〔adjusted OR=0.95，95%CI（0.90，1.00），P=0.06〕.Conclusion　Meta-analyses of cohort and case-control studies with an adjusted OR showed that beta-blocker exposure did not increase the risk of falls in older adults.In consideration of the quantity and quality of included studies，this result needs to be further confirmed by larger prospective cohort studies.

Key words: Adrenergic beta-antagonists, Accidental falls, Aged, Meta-analysis

摘要： 背景　降压药与老年人跌倒的风险关系存在争议，β-受体阻滞剂作为常见的降压药，与老年人跌倒的关系尚不明确。目的　系统评价β-受体阻滞剂与老年人跌倒风险的关系，为相关临床决策提供依据。方法　计算机检索PubMed、EMBase、CENTRAL、CINAHL、中国生物医学文献数据库、中国知网、维普网和万方数据知识服务平台，检索日期均为建库至2017年11月，全面收集β-受体阻滞剂与老年人跌倒关系的队列研究和病例对照研究，由两名评价者按照纳入与排除标准对所获文献独立进行文献筛选、资料提取并采用纽卡斯尔-渥太华量表（NOS）进行方法学质量评价，应用RevMan 5.3软件对提取数据进行Meta分析。结果　共纳入13项研究，包括8项队列研究、5项病例对照研究，共72 539例患者。队列研究Meta分析结果显示：未校正OR值的研究合并显示，β-受体阻滞剂不会增加老年人跌倒的风险〔OR=1.07，95%CI（0.98，1.18），P=0.14〕；校正OR值的研究合并显示，β-受体阻滞剂不会增加老年人跌倒的风险〔OR=1.04，95%CI（0.93，1.15），P=0.50〕。病例对照研究Meta分析结果显示：未校正OR值的研究合并显示，β-受体阻滞剂会增加老年人跌倒的风险〔OR=1.10，95%CI（1.05，1.15），P<0.000 1〕；校正OR值的研究合并显示，β-受体阻滞剂不会增加老年人跌倒的风险〔OR=0.95，95%CI（0.90，1.00），P=0.06〕。结论　基于队列研究、病例对照研究的校正OR值合并结果，表明β-受体阻滞剂不会增加老年人跌倒的风险。鉴于纳入研究数量及质量的局限性，结果有待于未来大样本前瞻性队列研究进一步验证。

关键词: 肾上腺素能&beta, 受体拮抗剂, 意外跌倒, 老年人, Meta分析