Cardiovascular Medicine Section, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA.
Curr Hypertens Rep. 2019 Jan 18;21(1):9. doi: 10.1007/s11906-019-0913-3.
Previous trials definitively established that lowering systolic blood pressure (BP) to 140 mmHg prevented heart failure (HF) exacerbations, but the potential benefits and risks of further BP reduction remain unclear due to a paucity of trial-based data.
A recent secondary analysis of the Systolic Blood Pressure Intervention Trial (SPRINT) found that in older, high-risk, non-diabetic participants with systolic hypertension, a BP treatment target < 120 mmHg resulted in a 36% lower rate of acute decompensated HF as compared with a BP target < 140 mmHg. Those participants with incident HF had a 26-fold increased risk of subsequent cardiovascular events and death. Based in part on the SPRINT results, the 2017 American Heart Association/American College of Cardiology/HF Society Guideline for the Management of HF acknowledged that targeting a significant reduction in BP in those at increased risk for cardiovascular disease is a novel risk-based strategy to prevent HF. SPRINT redefines systolic BP target goals in older, high-risk patients and provides a key opportunity for preventing HF in this patient group.
先前的试验明确表明，将收缩压（BP）降低到 140mmHg 可预防心力衰竭（HF）恶化，但由于试验数据有限，进一步降低血压的潜在益处和风险仍不清楚。
最近对收缩压干预试验（SPRINT）的二次分析发现，对于患有收缩期高血压的年龄较大、高危、非糖尿病患者，与收缩压目标<140mmHg 相比，收缩压治疗目标<120mmHg 可使急性失代偿性 HF 的发生率降低 36%。那些新发 HF 的患者随后发生心血管事件和死亡的风险增加了 26 倍。部分基于 SPRINT 的结果，2017 年美国心脏协会/美国心脏病学会/HF 学会心力衰竭管理指南承认，针对心血管疾病风险增加的患者显著降低血压是预防 HF 的一种新的基于风险的策略。SPRINT 重新定义了年龄较大、高危患者的收缩压目标，并为预防该患者群体的 HF 提供了一个关键机会。
