From the Epidemiological Cardiology Research Center, Department of Epidemiology and Prevention, Division of Public Health Sciences and Department of Medicine, Section on Cardiology, Wake Forest School of Medicine, Winston-Salem, NC (E.Z.S.).
Department of Biostatistics (A.F.R.), University of Alabama at Birmingham, Birmingham, AL.
Hypertension. 2020 Jun;75(6):1491-1496. doi: 10.1161/HYPERTENSIONAHA.120.14766. Epub 2020 May 4.
It remains uncertain whether intensive control of blood pressure (BP) results in a lower risk of atrial fibrillation (AF) in patients with hypertension. Using data from SPRINT (Systolic Blood Pressure Intervention Trial), which enrolled participants with hypertension at increased risk of cardiovascular disease, we examined whether intensive BP lowering (target systolic BP [SBP] <120 mm Hg), compared with standard BP lowering (target SBP<140 mm Hg), results in a lower risk of AF. This analysis included 8022 participants (4003 randomized to the intensive arm and 4019 to standard BP arm) who were free of AF at the time of enrollment and with available baseline and follow-up electrocardiographic data. AF was ascertained from standard 12-lead electrocardiograms recorded at biannual study examinations and an exit visit. During up to 5.2 years of follow-up and a total of 28 322 person-years, 206 incident AF cases occurred; 88 in the intensive BP-lowering arm and 118 in the standard BP-lowering arm. Intensive BP lowering was associated with a 26% lower risk of developing new AF (hazard ratio, 0.74 [95% CI, 0.56-0.98]; =0.037). This effect was consistent among prespecified subgroups of SPRINT participants stratified by age, sex, race, SBP tertiles, prior cardiovascular disease, and prior chronic kidney disease when interactions between treatment effect and these subgroups were assessed using Hommel adjusted values. In conclusion, intensive treatment to a target of SBP <120 mm Hg in patients with hypertension at high risk of cardiovascular disease has the potential to reduce the risk of AF. Registration- URL: https://www.clinicaltrials.gov; Unique identifier: NCT01206062.
目前尚不清楚强化血压控制是否会降低高血压患者心房颤动（AF）的风险。利用 SPRINT（收缩压干预试验）的数据，该研究纳入了心血管疾病风险增加的高血压患者，我们研究了与标准降压（目标收缩压[SBP] <140mmHg）相比，强化降压（目标 SBP<120mmHg）是否会降低 AF 的风险。这项分析纳入了 8022 名参与者（4003 名随机分配到强化组，4019 名分到标准 BP 组），他们在入组时没有 AF，且有基线和随访的心电图数据。AF 通过每两年进行一次研究检查和一次退出时的标准 12 导联心电图记录来确定。在最长 5.2 年的随访期间，共发生了 28322 人年的 206 例新发 AF 事件；强化 BP 降低组 88 例，标准 BP 降低组 118 例。强化 BP 降低与新发 AF 的风险降低 26%相关（风险比，0.74[95%CI，0.56-0.98]；=0.037）。当使用 Hommel 调整值评估治疗效果与这些亚组之间的交互作用时，在 SPRINT 参与者的预先指定亚组中，包括年龄、性别、种族、SBP 三分位数、既往心血管疾病和既往慢性肾脏病，这种效果是一致的。总之，对心血管疾病风险较高的高血压患者强化降压至 SBP<120mmHg 的目标，有可能降低 AF 的风险。注册-URL：https://www.clinicaltrials.gov；独特标识符：NCT01206062。
