New York University School of Medicine, New York, NY, USA.
Circulation. 2010 Nov 23;122(21):2142-51. doi: 10.1161/CIRCULATIONAHA.109.905687. Epub 2010 Nov 8.
Aggressive blood pressure (BP) control has been advocated in patients with acute coronary syndrome, but few data exist in this population relative to cardiovascular outcomes.
We evaluated 4162 patients enrolled in the PRavastatin Or atorVastatin Evaluation and Infection Therapy-Thrombolysis In Myocardial Infarction (PROVE IT-TIMI) 22 trial (acute coronary syndrome patients randomized to pravastatin 40 mg versus atorvastatin 80 mg). The average follow-up BP (systolic and diastolic) was categorized into 10-mm Hg increments. The primary outcome was a composite of death due to any cause, myocardial infarction, unstable angina requiring rehospitalization, revascularization after 30 days, and stroke. The secondary outcome was a composite of death due to coronary heart disease, nonfatal myocardial infarction, or revascularization. The relationship between BP (systolic or diastolic) followed a J- or U-shaped curve association with primary, secondary, and individual outcomes, with increased events rates at both low and high BP values, both unadjusted and after adjustment for baseline variables, baseline C-reactive protein, and on-treatment average levels of low-density lipoprotein cholesterol. A nonlinear Cox proportional hazards model showed a nadir of 136/85 mm Hg (range 130 to 140 mm Hg systolic and 80 to 90 mm Hg diastolic) at which the incidence of primary outcome was lowest. The curve was relatively flat for systolic pressures of 110 to 130 mm Hg and diastolic pressures of 70 to 90 mm Hg.
After acute coronary syndrome, a J- or U-shaped curve association existed between BP and the risk of future cardiovascular events, with lowest event rates in the BP range of approximately 130 to 140 mm Hg systolic and 80 to 90 mm Hg diastolic and a relatively flat curve for systolic pressures of 110 to 130 mm Hg and diastolic pressures of 70 to 90 mm Hg, which suggests that too low of a pressure (especially <110/70 mm Hg) may be dangerous.
URL: http://www.clinicaltrials.gov. Unique identifier: NCT00382460.
急性冠状动脉综合征患者主张积极控制血压（BP），但针对此类人群的心血管结局数据有限。
我们评估了 4162 名参加 PRavastatin Or atorVastatin Evaluation and Infection Therapy-Thrombolysis In Myocardial Infarction（PROVE IT-TIMI）22 试验（急性冠状动脉综合征患者随机接受普伐他汀 40mg 或阿托伐他汀 80mg）的患者。将平均随访 BP（收缩压和舒张压）分为 10mmHg 递增。主要终点是任何原因导致的死亡、心肌梗死、不稳定型心绞痛需要再住院、30 天后血运重建和卒中的复合终点。次要终点是因冠心病导致的死亡、非致死性心肌梗死或血运重建的复合终点。BP（收缩压或舒张压）与主要、次要终点及单个终点的关系呈 J 形或 U 形曲线，无论未调整还是根据基线变量、基线 C 反应蛋白和治疗期间 LDL 胆固醇平均水平进行调整，低 BP 值和高 BP 值均与事件发生率增加相关。非线性 Cox 比例风险模型显示，在 136/85mmHg 时（收缩压范围 130 至 140mmHg，舒张压范围 80 至 90mmHg）主要终点的发生率最低，曲线较为平坦（收缩压 110 至 130mmHg，舒张压 70 至 90mmHg）。
急性冠状动脉综合征后，BP 与未来心血管事件风险之间存在 J 形或 U 形曲线关系，收缩压 130 至 140mmHg 舒张压 80 至 90mmHg 时事件发生率最低，收缩压 110 至 130mmHg 舒张压 70 至 90mmHg 时曲线较为平坦，提示 BP 过低（尤其是<110/70mmHg）可能有危险。
