George Institute for International Health, University of Sydney, Sydney, Australia.
Hypertension. 2010 May;55(5):1193-8. doi: 10.1161/HYPERTENSIONAHA.109.140624. Epub 2010 Mar 8.
There is considerable uncertainty regarding the efficacy of blood pressure-lowering therapy in reducing cardiovascular risk in obese people. In this report we examine the effects of blood pressure lowering according to baseline body mass index (kilograms per meter squared) in the Perindopril Protection Against Recurrent Stroke Study. A total of 6105 participants with cerebrovascular disease were randomized to perindopril-based blood pressure-lowering therapy or placebo. The overall mean difference in systolic/diastolic blood pressure between participants assigned active therapy or placebo was 9/4 mm Hg (SE: 0.5/0.3 mm Hg), with no difference by body mass index quarters (<23.1, 23.1 to 25.3, 25.4 to 27.8, and > or = 27.9 kg/m(2)). A consistent treatment benefit was demonstrated for protection against major vascular events across quarters with the following hazard ratios (95% CIs): 0.80 (0.62 to 1.02), 0.78 (0.61 to 1.01), 0.67 (0.53 to 0.86), 0.69 (0.54 to 0.88), and 0.74 (0.66 to 0.84; P for heterogeneity=0.16). Similar results were apparent for stroke and stroke subtypes (all P for heterogeneity > or = 0.07) or with the standard definitions of overweight and obesity (<25, 25 to 29, and > or = 30 kg/m(2); all P for heterogeneity > or = 0.28). The absolute effects of treatment were, however, more than twice that in the highest compared with the lowest body mass index quartile. Across increasing quarters of body mass index over 5 years, active therapy prevented 1 major vascular event among every 28, 23, 13, and 13 patients treated. In conclusion, blood pressure-lowering therapy produced comparable risk reductions in vascular disease across the whole range of body mass indices in participants with a history of stroke. However, the greater baseline level of cardiovascular risk in those with higher body mass index meant that these patients obtained the greatest benefit.
在降低肥胖人群心血管风险方面，降压治疗的疗效存在较大不确定性。在本报告中，我们根据基线体重指数（千克/平方米）检查降压治疗对预防复发性卒中的效果。共有 6105 名脑血管病患者被随机分配到培哚普利为基础的降压治疗或安慰剂组。与接受活性治疗或安慰剂治疗的参与者之间的收缩压/舒张压总体平均差异为 9/4mmHg（SE：0.5/0.3mmHg），体重指数四分之一区间内无差异（<23.1、23.1 至 25.3、25.4 至 27.8 和≥27.9kg/m2）。在所有四分之一区间内，主要血管事件的保护均显示出一致的治疗益处，以下危险比（95%CI）：0.80（0.62 至 1.02）、0.78（0.61 至 1.01）、0.67（0.53 至 0.86）、0.69（0.54 至 0.88）和 0.74（0.66 至 0.84；异质性 P 值=0.16）。在卒中及卒中亚型（所有异质性 P 值≥0.07）或超重和肥胖的标准定义（<25、25 至 29 和≥30kg/m2；所有异质性 P 值≥0.28）中，也有类似的结果。然而，与体重指数最低四分之一组相比，治疗的绝对效果高出两倍以上。在 5 年内，体重指数四分之一逐渐升高，每治疗 28、23、13 和 13 例患者，就有 1 例主要血管事件得到预防。总之，降压治疗在有卒中病史的参与者的整个体重指数范围内都能产生相当的血管疾病风险降低。然而，体重指数较高者的心血管风险基线水平较高，意味着这些患者获益最大。
