Medical Service, Veterans Affairs Salt Lake City Health Care System, UT (S.B., A.K.C.)
Division of Nephrology and Hypertension (S.B., A.K.C., G.W.).
Circulation. 2018 Jan 9;137(2):134-143. doi: 10.1161/CIRCULATIONAHA.117.030848. Epub 2017 Oct 11.
In individuals with a low diastolic blood pressure (DBP), the potential benefits or risks of intensive systolic blood pressure (SBP) lowering are unclear.
SPRINT (Systolic Blood Pressure Intervention Trial) was a randomized controlled trial that compared the effects of intensive (target <120 mm Hg) and standard (target <140 mm Hg) SBP control in 9361 older adults with high blood pressure at increased risk of cardiovascular disease. The primary outcome was a composite of cardiovascular disease events. All-cause death and incident chronic kidney disease were secondary outcomes. This post hoc analysis examined whether the effects of the SBP intervention differed by baseline DBP.
Mean baseline SBP and DBP were 139.7±15.6 and 78.1±11.9 mm Hg, respectively. Regardless of the randomized treatment, baseline DBP had a U-shaped association with the hazard of the primary cardiovascular disease outcome. However, the effects of the intensive SBP intervention on the primary outcome were not influenced by baseline DBP level ( for interaction=0.83). The primary outcome hazard ratio for intensive versus standard treatment was 0.78 (95% confidence interval, 0.57-1.07) in the lowest DBP quintile (mean baseline DBP, 61±5 mm Hg) and 0.74 (95% confidence interval, 0.61-0.90) in the upper 4 DBP quintiles (mean baseline DBP, 82±9 mm Hg), with an interaction value of 0.78. Results were similar for all-cause death and kidney events.
Low baseline DBP was associated with increased risk of cardiovascular disease events, but there was no evidence that the benefit of the intensive SBP lowering differed by baseline DBP.
URL: https://www.clinicaltrials.gov. Unique identifier: NCT01206062.
在舒张压（DBP）较低的个体中，强化收缩压（SBP）降低的潜在益处或风险尚不清楚。
SPRINT（收缩压干预试验）是一项随机对照试验，比较了强化（目标<120mmHg）和标准（目标<140mmHg）SBP 控制在 9361 名患有高血压且心血管疾病风险增加的老年人中的效果。主要结局是心血管疾病事件的综合指标。全因死亡和新发慢性肾脏病是次要结局。本事后分析检查了 SBP 干预的效果是否因基线 DBP 而不同。
平均基线 SBP 和 DBP 分别为 139.7±15.6 和 78.1±11.9mmHg。无论随机治疗如何，基线 DBP 与主要心血管疾病结局的风险呈 U 形关联。然而，强化 SBP 干预对主要结局的影响不受基线 DBP 水平的影响（交互作用值=0.83）。在最低 DBP 五分位数（平均基线 DBP，61±5mmHg）中，强化治疗与标准治疗相比，主要结局的危险比为 0.78（95%置信区间，0.57-1.07），在 4 个较高 DBP 五分位数中（平均基线 DBP，82±9mmHg），危险比为 0.74（95%置信区间，0.61-0.90），交互作用值为 0.78。全因死亡和肾脏事件的结果相似。
低基线 DBP 与心血管疾病事件风险增加相关，但没有证据表明强化 SBP 降低的益处因基线 DBP 而异。
