Fan Fangfang, Yuan Ziwen, Qin Xianhui, Li Jianping, Zhang Yan, Li Youbao, Yu Tao, Ji Meng, Ge Junbo, Zheng Meili, Yang Xinchun, Bao Huihui, Cheng Xiaoshu, Gu Dongfeng, Zhao Dong, Wang Jiguang, Sun Ningling, Chen Yundai, Wang Hong, Wang Xiaobin, Parati Gianfranco, Hou Fanfan, Xu Xiping, Wang Xian, Zhao Gang, Huo Yong
From the Department of Cardiology, Peking University First Hospital, Beijing, China (F.F., J.L., Y.Z., Y.H.); Department of Neurology, Xijing Hospital, the Fourth Military Medical University, Xi'an, China (Z.Y., G.Z.); National Clinical Research Center for Kidney Disease; State Key Laboratory for Organ Failure Research; Renal Division, Nanfang Hospital, Southern Medical University, Guangzhou, China (X.Q., Y.L., F.H., X.X.); Institute for Biomedicine, Anhui Medical University, Hefei, China (X.Q., T.Y.); Shanghai Institute of Cardiovascular Diseases, Department of Cardiology, Zhongshan Hospital (M.J., J.G.), and Institutes of Biomedical Sciences (M.J., J.G.), Fudan University, Shanghai, China; Department of Cardiology, Beijing Chaoyang Hospital, Capital Medical University, China (M.Z., X.Y.); Department of Cardiology, Second Affiliated Hospital, Nanchang University, China (H.B., X.C.); Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (D.G.); Department of Epidemiology, Capital Medical University Beijing Anzhen Hospital-Beijing Institute of Heart, Lung & Blood Vessel Diseases, China (D.Z.); Centre for Epidemiological Studies and Clinical Trials, Ruijin Hospital, The Shanghai Institute of Hypertension, Shanghai Jiaotong University School of Medicine, China (J.W.); Department of Cardiology, Peking University People's Hospital, Beijing, China (N.S.); Department of Cardiology, Chinese People's Liberation Army General Hospital, Beijing, China (Y.C.); Centers for Metabolic Disease Research, Temple University School of Medicine, Philadelphia, PA (H.W.); Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (Xiaobin Wang); Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, Istituto Auxologico Italiano, Milan, Italy (G.P.); Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy (G.P.); and Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Peking University, Beijing, China (Xian Wang).
Hypertension. 2017 Apr;69(4):697-704. doi: 10.1161/HYPERTENSIONAHA.116.08499. Epub 2017 Feb 27.
We aimed to investigate the relationship of time-averaged on-treatment systolic blood pressure (SBP) with the risk of first stroke in the CSPPT (China Stroke Primary Prevention Trial). A post hoc analysis was conducted using data from 17 720 hypertensive adults without cardiovascular disease, diabetes mellitus, and renal function decline from the CSPPT, a randomized double-blind controlled trial. The primary outcome was first stroke. Over a median follow-up duration of 4.5 years, the association between averaged on-treatment SBP and risk for first stoke followed a U-shape curve, with increased risk above and below the reference range of 120 to 130 mm Hg. Compared with participants with time-averaged on-treatment SBP at 120 to 130 mm Hg (mean, 126.2 mm Hg), the risk of first stroke was not only increased in participants with SBP at 130 to 135 mm Hg (mean, 132.6 mm Hg; 1.5% versus 0.8%; hazard ratio, 1.63; 95% confidence interval, 1.01-2.63) or 135 to 140 mm Hg (mean, 137.5 mm Hg; 1.9% versus 0.8%; hazard ratio, 1.85; 95% confidence interval, 1.17-2.93), but also increased in participants with SBP <120 mm Hg (mean, 116.7 mm Hg; 3.1% versus 0.8%; hazard ratio, 4.37; 95% confidence interval, 2.10-9.07). Similar results were found in various subgroups stratified by age, sex, and treatment group. Furthermore, lower diastolic blood pressure was associated with lower risk of stroke, with a plateau at a time-average on-treatment diastolic blood pressure <80 mm Hg. In conclusion, among adults with hypertension and without a history of stroke or myocardial infarction, diabetes mellitus, or renal function decline, a lower SBP goal of 120 to 130 mm Hg, as compared with a target SBP of 130 to 140 mm Hg or <120 mm Hg, resulted in the lowest risk of first stroke.
我们旨在研究中国脑卒中一级预防试验（CSPPT）中治疗期平均收缩压（SBP）与首次卒中风险之间的关系。我们利用CSPPT试验中17720例无心血管疾病、糖尿病和肾功能减退的高血压成人患者的数据进行了一项事后分析，该试验为随机双盲对照试验。主要结局为首次卒中。在中位随访期4.5年期间，治疗期平均SBP与首次卒中风险之间的关联呈U形曲线，在120至130 mmHg的参考范围之上和之下风险均升高。与治疗期平均SBP为120至130 mmHg（平均126.2 mmHg）的参与者相比，SBP为130至135 mmHg（平均132.6 mmHg；1.5%对0.8%；风险比，1.63；95%置信区间，1.01 - 2.63）或135至140 mmHg（平均137.5 mmHg；1.9%对0.8%；风险比，1.85；95%置信区间，1.17 - 2.93）的参与者首次卒中风险不仅增加，SBP <120 mmHg（平均116.7 mmHg；3.1%对0.8%；风险比，4.37；95%置信区间，2.10 - 9.07）的参与者首次卒中风险也增加。在按年龄、性别和治疗组分层的各个亚组中发现了类似结果。此外，舒张压越低与卒中风险越低相关，在治疗期平均舒张压<80 mmHg时趋于平稳。总之，在无卒中或心肌梗死病史、糖尿病或肾功能减退的高血压成人中，与目标SBP为130至140 mmHg或<120 mmHg相比，较低的SBP目标120至130 mmHg导致首次卒中风险最低。
Zotero 插件