强化抗高血压治疗会在冠状动脉疾病合并高血压患者血管重建术后产生“J曲线效应”吗？

Could intensive anti-hypertensive therapy produce the "J-curve effect" in patients with coronary artery disease and hypertension after revascularization?

作者信息

Lu W

机构信息

Cardiology Department, Xuzhou Central Hospital, Xuzhou, China.

出版信息

Eur Rev Med Pharmacol Sci. 2016 Apr;20(7):1350-5.

PMID:27097958

Abstract

OBJECTIVE

Intervention and prospective long-term follow-up was performed to observe the presence of the "J-curve effect" in patients with Coronary Artery Disease (CAD) who underwent intensive anti-hypertensive therapy after (PCI or CABG).

PATIENTS AND METHODS

Four hundred and thirty-six successive CAD patients were included in this study, 67 patients with CAD only (Group A) and the 369 patients with both CAD and hypertension who were randomly assigned to Group B (no control of blood pressure (BP), n=72), Group C (n=83, target BP 130-140/80-90 mmHg), Group D (n=78, target BP 120-130/75-80 mmHg), Group E (n=74, target BP 110-120/70-75 mmHg) and Group F (n=62, target BP <110/70 mmHg). All patients had undergone revascularization and anti-hypertensive therapy. The composite endpoint was the end of the follow-up, i.e. major adverse cardiac events (MACE) (cardiac death, nonfatal myocardial infarction and target vessel revascularization) and stroke.

RESULTS

Results showed that smoking, total cholesterol (Tc), low density lipoprotein-C (LDL-C), high-sensitivity C-reactive protein (hs-CRP), β-blockers, ACEI or ARB (except for Group A and Group B), diuretics and follow-up duration among the 6 groups were not significantly different, However significantly lower than those results on admission (p<0.05). The difference between systolic blood pressure (SBP) and diastolic blood pressure (DBP) was significant, p<0.05, both BP achieved target values. 2) The "J-curve effect" was present in the actual occurrence of composite endpoint and MACE for SBP and DBP, with a reasonable BP-lowering range of 120-130/75-80 mmHg, while the "J-curve effect" was absent in the occurrence of stroke.

CONCLUSIONS

For the patients who had CAD and hypertension, intensive anti-hypertensive therapy could produce the "J-curve effect" after revascularization with the optimal blood pressure (BP) range being 120-130/75-80 mmHg.

摘要

目的

进行干预及前瞻性长期随访，以观察冠心病（CAD）患者在经皮冠状动脉介入治疗（PCI）或冠状动脉旁路移植术（CABG）后接受强化抗高血压治疗时“J曲线效应”的存在情况。

患者与方法

本研究纳入436例连续的CAD患者，其中仅患有CAD的患者67例（A组），369例同时患有CAD和高血压的患者被随机分为B组（血压未控制，n = 72）、C组（n = 83，目标血压130 - 140/80 - 90 mmHg）、D组（n = 78，目标血压120 - 130/75 - 80 mmHg）、E组（n = 74，目标血压110 - 120/70 - 75 mmHg）和F组（n = 62，目标血压<110/70 mmHg）。所有患者均接受了血运重建和抗高血压治疗。复合终点为随访结束时的主要不良心脏事件（MACE）（心源性死亡、非致死性心肌梗死和靶血管血运重建）及卒中。

结果

1）结果显示，6组患者的吸烟、总胆固醇（Tc）、低密度脂蛋白胆固醇（LDL - C）、高敏C反应蛋白（hs - CRP）、β受体阻滞剂、血管紧张素转换酶抑制剂（ACEI）或血管紧张素Ⅱ受体拮抗剂（ARB）（A组和B组除外）、利尿剂及随访时间差异均无统计学意义，但均显著低于入院时结果（p < 0.05）。收缩压（SBP）和舒张压（DBP）之间差异有统计学意义，p < 0.05，两组血压均达到目标值。2）在复合终点和MACE的实际发生情况中，SBP和DBP存在“J曲线效应”，合理的血压降低范围为120 - 130/75 - 80 mmHg，而卒中发生情况中不存在“J曲线效应”。