Department of Rehabilitation Medicine, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.
Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.
J Hum Hypertens. 2018 Feb;32(2):94-104. doi: 10.1038/s41371-017-0026-x. Epub 2018 Jan 9.
Uncertainties still remain in terms of the efficacy of anti-hypertensive treatment on the risk of major cardiovascular (CV) events within prehypertensive levels. This review aims to assess the efficacy and safety of anti-hypertensives on the CV risks in populations within prehypertensive levels. Randomized controlled trials (RCTs) concerning active treatment vs placebo in populations within prehypertensive levels were identified through electronic database and manual search. Outcomes included the first co-primary outcomes, stroke, heart failure (HF), myocardial infarction (MI), all-cause mortality, and cardiovascular mortality. The first co-primary outcomes were defined as composite cardiovascular disease (CVD) events in the included studies. A total of 29 RCTs involving 127,641 participants were identified. Pooled analysis showed active treatment was associated with a significant 7% reduction in risk of the first co-primary outcomes, 14% in stroke, and 10% in HF as compared to placebo (0.86, 0.77-0.96; 0.93, 0.89-0.98; and 0.90, 0.83-0.97). However, there were no significant reductions in risk of MI, all-cause mortality, and cardiovascular mortality. A significant reduction in risk of the first co-primary outcomes was observed in subpopulations with systolic blood pressure (SBP) 130-139 mmHg (0.94, 0.89-0.99) or prior CVDs (0.88, 0.82-0.94). Meta-regression analyses showed no significant relative risk reductions proportional to the magnitude of the mean baseline BP, mean on-treatment BP, the mean absolute change in BP, the proportion of patients with hypertension, and mean age. In summary, anti-hypertensive treatment has beneficial cardiovascular effects in populations within prehypertensive levels, especially in subpopulations with SBP 130-139 mmHg or prior CVDs.
在血压处于正常高值范围内时，抗高血压治疗对主要心血管（CV）事件风险的疗效仍存在不确定性。本综述旨在评估降压治疗在血压正常高值范围内人群中的 CV 风险的疗效和安全性。通过电子数据库和手动搜索，确定了关于血压正常高值范围内人群的积极治疗与安慰剂对照的随机对照试验（RCT）。结局包括主要复合结局的首次复合结局、卒中、心力衰竭（HF）、心肌梗死（MI）、全因死亡率和心血管死亡率。首次主要复合结局被定义为纳入研究中的复合心血管疾病（CVD）事件。共确定了 29 项涉及 127641 名参与者的 RCT。汇总分析显示，与安慰剂相比，积极治疗与首次主要复合结局风险降低 7%、卒中风险降低 14%和 HF 风险降低 10%相关（0.86，0.77-0.96；0.93，0.89-0.98；0.90，0.83-0.97）。然而，MI、全因死亡率和心血管死亡率的风险降低无统计学意义。在收缩压（SBP）为 130-139mmHg 的亚人群（0.94，0.89-0.99）或有既往 CVD 的亚人群（0.88，0.82-0.94）中观察到首次主要复合结局风险显著降低。Meta 回归分析显示，与平均基线 BP、治疗期间平均 BP、BP 平均绝对变化、高血压患者比例和平均年龄的幅度相比，相对风险降低无显著比例。总之，降压治疗对血压正常高值范围内的人群有心血管获益，特别是在 SBP 为 130-139mmHg 或有既往 CVD 的亚人群中。
