Department of Cardiovascular Diseases, Mount Sinai St. Luke's & Mount Sinai West Hospitals, New York, New York.
Leon H. Charney Division of Cardiology, New York University School of Medicine, New York, New York.
J Am Coll Cardiol. 2017 Feb 7;69(5):486-493. doi: 10.1016/j.jacc.2016.10.077.
The 2014 Eighth Joint National Committee panel recommended a therapeutic target of systolic blood pressure (BP) <150 mm Hg in patients ≥60 years of age, a departure from prior recommendation of <140 mm Hg.
This study assessed the efficacy and safety of intensive BP-lowering strategies in older (age ≥65 years) hypertensive patients.
The MEDLINE, Scopus, EMBASE, and Cochrane databases were searched for all relevant randomized controlled trials from 1965 through July 1, 2016. Cardiovascular (major adverse cardiovascular events [MACE], cardiovascular mortality, stroke, myocardial infarction, and heart failure), and safety (serious adverse events and renal failure) were evaluated. Random and fixed effects analysis were used to calculate pooled relative risks (RRs) and 95% confidence intervals (CIs).
We identified 4 high-quality trials involving 10,857 older hypertensive patients with a mean follow-up of 3.1 years. Intensive BP lowering was associated with a 29% reduction in MACE (RR: 0.71; 95% CI: 0.60 to 0.84), 33% in cardiovascular mortality (RR: 0.67; 95% CI: 0.45 to 0.98), and 37% in heart failure (RR: 0.63; 95% CI: 0.43 to 0.99) compared with standard BP lowering. Rates of myocardial infarction and stroke did not differ between the 2 groups. There was no significant difference in the incidence of serious adverse events (RR: 1.02; 95% CI: 0.94 to 1.09) or renal failure (RR: 1.81; 95% CI: 0.86 to 3.80) between the 2 groups. The fixed effects model yielded largely similar results, except for an increase in the risk of renal failure (RR: 2.03; 95% CI: 1.30 to 3.18) with intensive BP-lowering therapy.
In older hypertensive patients, intensive BP control (systolic BP <140 mm Hg) decreased MACE, including cardiovascular mortality and heart failure. Data on adverse events were limited, but suggested an increased risk of renal failure. When considering intensive BP control, clinicians should carefully weigh benefits against potential risks.
2014 年第八届联合国家委员会小组建议，年龄≥60 岁的患者收缩压（BP）的治疗目标<150mmHg，这与之前建议的<140mmHg 有所不同。
本研究评估了强化降压策略在老年（年龄≥65 岁）高血压患者中的疗效和安全性。
从 1965 年到 2016 年 7 月 1 日，我们在 MEDLINE、Scopus、EMBASE 和 Cochrane 数据库中搜索了所有相关的随机对照试验。评估了心血管（主要不良心血管事件[MACE]、心血管死亡率、卒中和心力衰竭）和安全性（严重不良事件和肾衰竭）。采用随机和固定效应分析计算合并相对风险（RR）和 95%置信区间（CI）。
我们确定了 4 项高质量的试验，共纳入 10857 例老年高血压患者，平均随访 3.1 年。强化降压与 MACE 降低 29%相关（RR：0.71；95%CI：0.60 至 0.84）、心血管死亡率降低 33%（RR：0.67；95%CI：0.45 至 0.98）和心力衰竭降低 37%（RR：0.63；95%CI：0.43 至 0.99）相比，标准降压。两组间心肌梗死和卒中等不良事件发生率无显著差异。两组间严重不良事件（RR：1.02；95%CI：0.94 至 1.09）或肾衰竭（RR：1.81；95%CI：0.86 至 3.80）发生率无显著差异。固定效应模型得出的结果基本相似，除了强化降压治疗后肾衰竭的风险增加（RR：2.03；95%CI：1.30 至 3.18）。
在老年高血压患者中，强化血压控制（收缩压<140mmHg）可降低 MACE，包括心血管死亡率和心力衰竭。关于不良事件的数据有限，但提示肾衰竭风险增加。在考虑强化血压控制时，临床医生应仔细权衡利弊。
