Department of Cardiology, China-Japan Friendship Hospital, Beijing, China (mainland).
Department of Ultrasound Diagnosis, China-Japan Friendship Hospital, Beijing, China (mainland).
Med Sci Monit. 2019 Aug 1;25:5717-5726. doi: 10.12659/MSM.914482.
BACKGROUND Different blood pressure targets should be formulated for different groups of people. This study aimed to assess the effectiveness of intensive blood control in improving the carotid morphology and hemodynamics in Chinese patients with hyperhomocysteinemia-type hypertension and high risk of stroke. MATERIAL AND METHODS Chinese hypertensive patients with high risk of stroke were randomized to intensive (n=187) and standard (n=192; controls) blood pressure management groups. Systolic blood pressure (SBP) targets were 100< SBP ≤120 and 120< SBP ≤140 mmHg, respectively. All patients received folic acid 0.8 mg/d and atorvastatin 20 mg/d. Calcium antagonist was first used. If blood pressure was still uncontrolled, angiotensin-converting enzyme inhibitor or angiotensin receptor antagonist, ß-receptor blocker, and diuretics were added successively. Follow-up was 12 months. Carotid features, hemodynamics, and adverse events were examined. RESULTS There were no differences in sex, age, body mass index, blood lipids, baseline carotid parameters, and histories of smoking, diabetes, statin use, and stroke between the 2 groups. Carotid plaques after 12 months of treatment were 19.4±2.1 and 23.6±3.1 cm² for the intensive and control groups, respectively (P=0.038). Plaque scores were lower in the intensive group (1.75±0.52 vs. 2.45±0.47, P=0.023). Compared with controls, intensive management resulted in relatively higher Vd and significantly lower Vs/Vd, PI, and RI (all P<0.05). Major adverse events such as hypotension (n=5 (2.7%) vs. 3 (1.6%), P=0.020) and dizziness (n=20 (10.7%) vs. 16 (8.3%), P=0.041) were more frequent in the intensive group. CONCLUSIONS Intensive blood pressure management could be beneficial for Chinese patients with hyperhomocysteinemia-type hypertension and high risk of stroke.
不同人群应制定不同的血压目标。本研究旨在评估强化血压控制对改善伴有高同型半胱氨酸血症的中国高血压高危患者颈动脉形态和血液动力学的效果。
将中国高血压高危卒中患者随机分为强化（n=187）和标准（n=192；对照组）血压管理组。收缩压（SBP）目标分别为 100< SBP ≤120 和 120< SBP ≤140mmHg。所有患者均接受叶酸 0.8mg/d 和阿托伐他汀 20mg/d。首先使用钙拮抗剂。如果血压仍未得到控制，则依次加用血管紧张素转换酶抑制剂或血管紧张素受体拮抗剂、β受体阻滞剂和利尿剂。随访 12 个月。检查颈动脉特征、血液动力学和不良事件。
两组间性别、年龄、体重指数、血脂、基线颈动脉参数以及吸烟、糖尿病、他汀类药物使用和卒中史无差异。治疗 12 个月后，强化组和对照组颈动脉斑块分别为 19.4±2.1 和 23.6±3.1cm²（P=0.038）。强化组斑块评分较低（1.75±0.52 比 2.45±0.47，P=0.023）。与对照组相比，强化治疗组 Vd 较高，Vs/Vd、PI 和 RI 较低（均 P<0.05）。强化组低血压不良事件（n=5（2.7%）比 3（1.6%），P=0.020）和头晕不良事件（n=20（10.7%）比 16（8.3%），P=0.041）更为常见。
强化血压管理可能对伴有高同型半胱氨酸血症的中国高血压高危患者有益。
