Frances Payne Bolton School of Nursing, Case Western Reserve University, USA.
Wake Forest School of Medicine/Department of Epidemiology and Prevention, Section on Cardiovascular Medicine, USA.
Am J Hypertens. 2017 Dec 8;31(1):97-107. doi: 10.1093/ajh/hpx138.
The Systolic Blood Pressure Intervention Trial (SPRINT) showed that targeting a systolic blood pressure (SBP) of ≤ 120 mm Hg (intensive treatment) reduced cardiovascular disease (CVD) events compared to SBP of ≤ 140 mm Hg (standard treatment); however, it is unclear if this effect is similar in all racial/ethnic groups.
We analyzed SPRINT data within non-Hispanic White (NHW), non-Hispanic Black (NHB), and Hispanic subgroups to address this question. High-risk nondiabetic hypertensive patients (N = 9,361; 30% NHB; 11% Hispanic) 50 years and older were randomly assigned to intensive or standard treatment. Primary outcome was a composite of the first occurrence of a myocardial infarction, acute coronary syndrome, stroke, decompensated heart failure, or CVD death.
Average postbaseline SBP was similar among NHW, NHB, and Hispanics in both treatment arms. Hazard ratios (HRs) (95% confidence interval) (intensive vs. standard treatment groups) for primary outcome were 0.70 (0.57-0.86), 0.71 (0.51-0.98), 0.62 (0.33-1.15) (interaction P value = 0.85) in NHW, NHB, and Hispanics. CVD mortality HRs were 0.49 (0.29-0.81), 0.77 (0.37-1.57), and 0.17 (0.01-1.08). All-cause mortality HRs were 0.61 (0.47-0.80), 0.92 (0.63-1.35), and 1.58 (0.73-3.62), respectively. A test for differences among racial/ethnic groups in the effect of treatment assignment on all-cause mortality was not significant (Hommel-adjusted P value = 0.062) after adjustment for multiple comparisons.
Targeting a SBP goal of ≤ 120 mm Hg compared to ≤ 140 mm Hg led to similar SBP control and was associated with similar benefits and risks among all racial ethnic groups, though NHBs required an average of ~0.3 more medications.
Trial Number NCT01206062, ClinicalTrials.gov Identifier at https://clinicaltrials.gov/ct2/show/NCT01206062.
收缩压干预试验（SPRINT）表明，与收缩压（SBP）目标值为 140mmHg 的标准治疗相比，将 SBP 控制在 120mmHg 以下（强化治疗）可降低心血管疾病（CVD）事件发生率；然而，目前尚不清楚这种效果是否在所有种族/民族群体中相似。
我们在非西班牙裔白人（NHW）、非西班牙裔黑人（NHB）和西班牙裔亚组内分析了 SPRINT 数据，以解决这个问题。纳入了 9361 例年龄在 50 岁及以上的高危非糖尿病高血压患者（30%为 NHB，11%为西班牙裔），并将其随机分配至强化治疗组或标准治疗组。主要终点为首次发生心肌梗死、急性冠脉综合征、卒中等复合终点事件，或 CVD 死亡。
强化治疗组和标准治疗组中，NHW、NHB 和西班牙裔患者的平均基线后 SBP 相似。主要终点事件的风险比（HR）（95%置信区间）（强化 vs. 标准治疗组）分别为 0.70（0.57-0.86）、0.71（0.51-0.98）和 0.62（0.33-1.15）（交互 P 值=0.85）。NHW、NHB 和西班牙裔患者的 CVD 死亡率 HR 分别为 0.49（0.29-0.81）、0.77（0.37-1.57）和 0.17（0.01-1.08）。全因死亡率 HR 分别为 0.61（0.47-0.80）、0.92（0.63-1.35）和 1.58（0.73-3.62）。对全因死亡率治疗效果的种族/民族差异进行检验，在进行多次比较调整后差异无统计学意义（Hommel 调整 P 值=0.062）。
与 SBP 目标值为 140mmHg 的标准治疗相比，将 SBP 目标值控制在 120mmHg 以下可带来相似的 SBP 控制效果，且与所有种族/民族群体的获益和风险相似，尽管 NHB 组需要平均多服用约 0.3 种药物。
试验编号 NCT01206062，ClinicalTrials.gov 标识符：https://clinicaltrials.gov/ct2/show/NCT01206062。
