Durham Veterans Affairs Geriatric Research Education and Clinical Center, Durham Veterans Affairs Medical Center (VAMC), Durham, North Carolina.
Department of Medicine, Duke University, Durham, North Carolina.
J Clin Hypertens (Greenwich). 2019 Apr;21(4):451-459. doi: 10.1111/jch.13515. Epub 2019 Mar 13.
Achieving blood pressure (BP) control is associated with lower cardiovascular disease (CVD) risk, but less is known about CVD risk associated with sustained BP control over time. This observational analysis of the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) was restricted to participants with four to seven visits with systolic BP (SBP) measurements during a 22-month period (n = 24 309). The authors categorized participants as having sustained BP control (SBP < 140 mm Hg) at 100%, 75% to <100%, 50% to <75%, and <50% of visits during this period. Outcomes included fatal coronary heart disease (CHD)/nonfatal myocardial infarction (MI), stroke, heart failure (HF), a composite CVD outcome (fatal CHD/nonfatal MI, stroke, or HF), and mortality. Hazard ratios (HRs) for the association of category of sustained BP control for each outcome were obtained using proportional hazards models. SBP control was present among 20.0% of participants at 100%, 16.4% at 75% to less than 100%, 27.0% at 50% to less than 75%, and 36.6% at less than 50% of visits. Compared to those with SBP control at 100% visits, adjusted HR (95% CI) among those with SBP control at <50% of visits was 1.16 (0.93-1.44) for fatal CHD/nonfatal MI, 1.71 (1.26-2.32) for stroke, 1.63 (1.30-2.06) for HF, 1.39 (1.20-1.62) for the composite CVD outcome, and 1.14 (0.99-1.30) for mortality. Sustained SBP control may be beneficial for preventing stroke, HF, and CVD outcomes in adults taking antihypertensive medication.
实现血压（BP）控制与降低心血管疾病（CVD）风险相关，但对于随着时间的推移持续 BP 控制与 CVD 风险之间的关联知之甚少。本项针对抗高血压和降脂治疗预防心脏病发作试验（ALLHAT）的观察性分析仅限于在 22 个月期间进行了 4 至 7 次收缩压（SBP）测量的参与者（n=24309）。作者将参与者分为在该期间的 100%、75%至<100%、50%至<75%和<50%的访视中持续 BP 控制（SBP<140mmHg）的患者。结局包括致命性冠心病（CHD）/非致死性心肌梗死（MI）、卒中和心力衰竭（HF）、复合 CVD 结局（致命性 CHD/非致死性 MI、卒中和 HF）和死亡率。使用比例风险模型获得了每个结局的持续 BP 控制类别与风险比（HR）之间的关联。在 100%的访视中，20.0%的参与者存在 SBP 控制，16.4%在 75%至<100%的访视中，27.0%在 50%至<75%的访视中，36.6%在<50%的访视中。与在 100%的访视中 SBP 控制的参与者相比，在<50%的访视中 SBP 控制的参与者调整后的 HR（95%CI）为致命性 CHD/非致死性 MI 为 1.16（0.93-1.44），卒中和 HF 为 1.71（1.26-2.32），复合 CVD 结局为 1.63（1.30-2.06），死亡率为 1.14（0.99-1.30）。在服用抗高血压药物的成年人中，持续的 SBP 控制可能有益于预防卒中和 HF 以及 CVD 结局。
