Institute of Clinical Pharmacology and Toxicology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, Berlin, Germany.
Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, 3755 Côte Ste-Catherine Road, Montreal, Quebec, Canada.
Eur Heart J. 2019 Jul 1;40(25):2021-2028. doi: 10.1093/eurheartj/ehz071.
To assess whether blood pressure (BP) values below 140/90 mmHg during antihypertensive treatment are associated with a decreased risk of all-cause mortality in community-dwelling older adults.
Within the Berlin Initiative Study, we assembled a cohort of patients ≥70 years treated with antihypertensive drugs at baseline (November 2009-June 2011). End of prospective follow-up was December 2016. Cox proportional hazards models yielded adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) of all-cause mortality associated with normalized BP [systolic BP (SBP) <140 mmHg and diastolic BP (DBP) <90 mmHg] compared with non-normalized BP (SBP ≥140 mmHg or DBP ≥90 mmHg) overall and after stratification by age or previous cardiovascular events. Among 1628 patients (mean age 81 years) on antihypertensive drugs, 636 exhibited normalized BP. During 8853 person-years of follow-up, 469 patients died. Compared with non-normalized BP, normalized BP was associated with an increased risk of all-cause mortality (incidence rates: 60.3 vs. 48.5 per 1000/year; HR 1.26; 95% CI 1.04-1.54). Increased risks were observed in patients ≥80 years (102.2 vs. 77.5 per 1000/year; HR 1.40; 95% CI 1.12-1.74) and with previous cardiovascular events (98.3 vs. 63.6 per 1000/year; HR 1.61; 95% CI 1.14-2.27) but not in patients aged 70-79 years (22.6 vs. 22.7 per 1000/year; HR 0.83; 95% CI 0.54-1.27) or without previous cardiovascular events (45.2 vs. 44.4 per 1000/year; HR 1.16, 95% CI 0.90-1.48).
Blood pressure values below 140/90 mmHg during antihypertensive treatment may be associated with an increased risk of mortality in octogenarians or elderly patients with previous cardiovascular events.
评估降压治疗期间血压值低于 140/90mmHg 是否与社区居住的老年患者全因死亡率降低相关。
在柏林倡议研究中，我们组建了一个基线时（2009 年 11 月至 2011 年 6 月）接受降压药物治疗且年龄≥70 岁的患者队列。前瞻性随访结束于 2016 年 12 月。Cox 比例风险模型得出了与正常血压（收缩压（SBP）<140mmHg 和舒张压（DBP）<90mmHg）相比，与非正常血压（SBP≥140mmHg 或 DBP≥90mmHg）相关的全因死亡率的校正风险比（HR）和 95%置信区间（CI），整体以及按年龄或既往心血管事件进行分层后。在 1628 名接受降压药物治疗的患者（平均年龄 81 岁）中，有 636 名患者的血压正常。在 8853 人年的随访期间，有 469 名患者死亡。与非正常血压相比，正常血压与全因死亡率增加相关（发生率：60.3 比 48.5/1000 人年；HR 1.26；95%CI 1.04-1.54）。在≥80 岁的患者（102.2 比 77.5/1000 人年；HR 1.40；95%CI 1.12-1.74）和有既往心血管事件的患者（98.3 比 63.6/1000 人年；HR 1.61；95%CI 1.14-2.27）中观察到更高的风险，但在 70-79 岁的患者（22.6 比 22.7/1000 人年；HR 0.83；95%CI 0.54-1.27）或无既往心血管事件的患者（45.2 比 44.4/1000 人年；HR 1.16，95%CI 0.90-1.48）中未观察到。
降压治疗期间血压值低于 140/90mmHg 可能与 80 岁以上或有既往心血管事件的老年患者死亡率增加相关。
