Division of Cardiology, New York University School of Medicine, New York, NY 10016, USA.
Heart. 2013 May;99(9):601-13. doi: 10.1136/heartjnl-2012-301968. Epub 2012 Aug 21.
Most guidelines for treatment of hypertension including the Joint National Committee-7 recommend a blood pressure (BP) goal of <140/90 mm Hg for hypertensive patients and a more aggressive goal of <130/80 mm Hg for patients with coronary artery disease (CAD), based largely on expert consensus.
To evaluate the BP targets in patients with CAD DATA SOURCES: PUBMED, EMBASE and CENTRAL Study Selection: Randomised clinical trials (RCTs) of antihypertensive therapy in patients with CAD, enrolling at least 100 patients, with achieved systolic pressure of <=135 mm Hg in the 'intensive BP' group and <=140 mm Hg in the 'standard BP' group with follow-up for at least 1 year and evaluating cardiovascular outcomes.
The following efficacy outcomes were extracted- all-cause mortality, cardiovascular mortality, myocardial infarction, stroke, angina pectoris, heart failure and revascularisation.
We identified 15 RCTs enrolling 66,504 participants with 276,328 patient-years of follow-up. Intensive BP group (≤ 135 mm Hg) was associated with a 15% decrease in heart failure rate and 10% decrease in stroke rate, driven largely by trials with a more intensive BP group (≤ 130 mm Hg), with similar outcomes for death and cardiovascular death and was associated with a 105% increase in the risk of hypotension. More intensive BP group (≤ 130 mm Hg) was also associated with a reduction in myocardial infarction and angina pectoris. The results were similar in a Bayesian random effects model. In addition, lower seemed to be better (based on regression analysis) for the outcomes of myocardial infarction, stroke, heart failure and perhaps angina.
The present body of evidence suggests that in patients with CAD, intensive systolic BP control to ≤ 135 mm Hg and possibly to ≤ 130 mm Hg is associated with a modest reduction in stroke and heart failure but at the expense of hypotension. Lower was better, although not consistently so for myocardial infarction, stroke, heart failure and perhaps angina. Further trials are needed to prove these findings.
包括第七联合国家委员会在内的大多数高血压治疗指南建议高血压患者的血压目标值<140/90mmHg，而对于冠心病（CAD）患者，血压目标值则更为激进，建议<130/80mmHg，这主要是基于专家共识。
评估 CAD 患者的血压目标值。
PubMed、EMBASE 和 Cochrane 图书馆。
纳入至少 100 例 CAD 患者的降压治疗随机临床试验（RCT），在“强化降压”组中收缩压达到<=135mmHg，在“标准降压”组中收缩压达到<=140mmHg，随访时间至少 1 年，并评估心血管结局。
提取以下疗效结局：全因死亡率、心血管死亡率、心肌梗死、卒、心绞痛、心力衰竭和血运重建。
我们共确定了 15 项 RCT，共纳入 66504 例患者，随访时间为 276328 患者年。强化降压组（<=135mmHg）的心力衰竭发生率降低 15%，卒中发生率降低 10%，这主要归因于降压幅度更大的试验，而死亡率和心血管死亡率无显著差异，低血压风险增加 105%。强化降压组（<=130mmHg）也与心肌梗死和心绞痛发生率降低相关。贝叶斯随机效应模型得出的结果相似。此外，基于回归分析，似乎更低的血压对心肌梗死、卒、心力衰竭甚至心绞痛结局更好。
现有证据表明，对于 CAD 患者，强化收缩压控制至<=135mmHg，可能控制至<=130mmHg，可适度降低卒和心力衰竭风险，但以低血压为代价。虽然对于心肌梗死、卒、心力衰竭和心绞痛，血压并非越低越好，但似乎更低的血压更好。需要进一步的试验来证实这些发现。
