Yano Yuichiro, Rakugi Hiromi, Bakris George L, Lloyd-Jones Donald M, Oparil Suzanne, Saruta Takao, Shimada Kazuyuki, Matsuoka Hiroaki, Imai Yutaka, Ogihara Toshio
From the Department of Preventive Medicine, University of Mississippi Medical Center, Jackson (Y.Y.); Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (Y.Y., D.M.L.-J.); Department of Geriatric and General Medicine, Osaka University Graduate School of Medicine, Japan (H.R., T.O.); Department of Medicine, Section of Endocrinology, Diabetes and Metabolism, ASH Comprehensive Hypertension Center, University of Chicago Medicine, IL (G.L.B.); Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham (S.O.); Keio University, Tokyo, Japan (T.S.); Shin-Oyama City Hospital, Oyama, Japan (K.S.); Dokkyo Medical University, Mibu, Japan (H.M.); Department of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan (Y.I.); and Morinomiya University of Medical Sciences, Osaka, Japan (T.O.).
Hypertension. 2017 Feb;69(2):220-227. doi: 10.1161/HYPERTENSIONAHA.116.08600. Epub 2017 Jan 3.
Our aim was to assess optimal on-treatment blood pressure (BP) at which cardiovascular disease (CVD) and all-cause mortality risks are minimized in Japanese older adults with isolated systolic hypertension. We used data from the VALISH study (Valsartan in Elderly Isolated Systolic Hypertension) that recruited older adults (n=3035; mean age, 76 years) with systolic BP (SBP) of ≥160 mm Hg and diastolic BP of <90 mm Hg. Patients were treated by valsartan. Patients were also categorized into 3 groups based on achieved on-treatment SBP of <130 mm Hg (n=317), 130 to <145 mm Hg (n=2025), or ≥145 mm Hg (n=693). The primary outcome was composite CVD (coronary heart disease, stroke, heart failure, cardiovascular deaths, other vascular diseases, and kidney diseases) with secondary outcome being all-cause mortality. Cox proportional hazards models were used to assess the CVD risk for each group. Over a median 3-year follow-up (8022 person-years), 93 CVD events and 52 deaths occurred. Using the on-treatment SBP of 130 to <145 mm Hg as reference stratum, the multivariable-adjusted hazard ratios and 95% confidence intervals of CVD and all-cause mortality risks for those with SBP<130 mm Hg were 2.08 (1.12-3.83) and 2.09 (0.93-4.71) and for those with SBP≥145 mm Hg were 2.29 (1.44-3.62) and 2.51 (1.35-4.66), respectively. On-treatment diastolic BP yielded no relationships with CVD or all-cause mortality risk. In conclusion, among Japanese older adults with isolated systolic hypertension, SBP in the range between 130 and 144 mm Hg was associated with minimal adverse outcomes and a reduction in CVD and all-cause mortality. The BP range will need to be confirmed in randomized controlled trials.
URL: https://www.clinicaltrials.gov. Unique identifier: NCT00151229.
我们的目的是评估日本单纯收缩期高血压老年患者中，使心血管疾病（CVD）和全因死亡率风险降至最低的最佳治疗期血压（BP）。我们使用了VALISH研究（老年单纯收缩期高血压患者缬沙坦治疗研究）的数据，该研究纳入了收缩压（SBP）≥160 mmHg且舒张压<90 mmHg的老年患者（n = 3035；平均年龄76岁）。患者接受缬沙坦治疗。患者还根据治疗期SBP分为3组：SBP<130 mmHg（n = 317）、130至<145 mmHg（n = 2025）或≥145 mmHg（n = 693）。主要结局是复合CVD（冠心病、中风、心力衰竭、心血管死亡、其他血管疾病和肾脏疾病），次要结局是全因死亡率。使用Cox比例风险模型评估每组的CVD风险。在中位3年随访期（8022人年）内，发生了93例CVD事件和52例死亡。以治疗期SBP为130至<145 mmHg作为参照组，SBP<130 mmHg者CVD和全因死亡率风险的多变量校正风险比及95%置信区间分别为2.08（1.12 - 3.83）和2.09（0.93 - 4.71），SBP≥145 mmHg者分别为2.29（1.44 - 3.62）和2.51（1.35 - 4.66）。治疗期舒张压与CVD或全因死亡率风险无相关性。总之，在日本单纯收缩期高血压老年患者中，SBP在130至144 mmHg之间与最低不良结局以及CVD和全因死亡率降低相关。该血压范围需要在随机对照试验中得到证实。
