在 ACTION 研究和 SBP 干预试验中，收缩压在 130 至 139mmHg 的成年人的结局。

Outcomes in adults with systolic blood pressure between 130 and 139 mmHg in Action to Control Cardiovascular Risk in Diabetes Blood Pressure trial and Systolic Blood Pressure Intervention Trial.

机构信息

University of Miami Miller School of Medicine, Miami, Florida.

Wake Forest School of Medicine, Winston-Salem, North Carolina.

出版信息

J Hypertens. 2020 Aug;38(8):1567-1577. doi: 10.1097/HJH.0000000000002437.

DOI:10.1097/HJH.0000000000002437

PMID:32371767

Abstract

BACKGROUND

Patients with stage 1 systolic hypertension have increased risk of cardiovascular disease (CVD) events.

METHODS

Using Cox models, we assess the effect of targeting an intensive SBP goal of less than 120 mmHg compared with standard SBP goal of less than 140 mmHg on the risk of CVD events in adults with stage 1 systolic hypertension with diabetes mellitus enrolled in Action to Control Cardiovascular Risk in Diabetes Blood Pressure trial (ACCORD BP) (n = 1901) and without diabetes mellitus enrolled in Systolic Blood Pressure Intervention Trial (SPRINT) (n = 3484) that used identical SBP goal interventions.

OUTCOMES

In ACCORD BP, the primary composite CVD outcome was the first occurrence of myocardial infarction, stroke, or CVD mortality. In SPRINT, the primary composite CVD outcome was the first occurrence of myocardial infarction, other acute coronary syndrome, stroke, heart failure, or CVD mortality.

RESULTS

In SPRINT, targeting an intensive SBP goal significantly reduced the risk of the primary CVD outcome [hazard ratio 0.75 (95% confidence interval, 0.58-0.98); events 1.78 vs. 2.37%/year]. In ACCORD BP, the relationships of SBP goal with the primary CVD outcome was modified by the glycemia goal intervention (interaction P = 0.039). In the standard glycemia subgroup (A1c target 7-7.9%), intensive SBP goal significantly reduced the risk of the primary CVD outcome [hazard ratio 0.61 (0.40-0.94); events 1.63 vs. 2.56%/year]. In the intensive glycemia subgroup (A1c target <6%), the risk of the primary CVD outcome was not significantly different between groups [hazard ratio 1.20 (0.76-1.89); events 1.91 vs. 1.60%/year].

CONCLUSION

Targeting an intensive SBP goal significantly reduced the risk of CVD events in patients with stage 1 systolic hypertension without diabetes and with diabetes on standard glycemia goal.

摘要

背景

1 期收缩期高血压患者发生心血管疾病（CVD）事件的风险增加。

方法

使用 Cox 模型，我们评估与标准收缩压目标（<140mmHg）相比，将目标收缩压目标设定为<120mmHg 对糖尿病患者 1 期收缩期高血压患者 CVD 事件风险的影响，这些患者来自糖尿病心血管风险行动研究（ACCORD BP）（n=1901），无糖尿病患者来自收缩压干预试验（SPRINT）（n=3484），这两项研究均采用了相同的收缩压目标干预措施。

结果

在 ACCORD BP 中，主要复合 CVD 结局是首次发生心肌梗死、中风或 CVD 死亡率。在 SPRINT 中，主要复合 CVD 结局是首次发生心肌梗死、其他急性冠状动脉综合征、中风、心力衰竭或 CVD 死亡率。

结果

在 SPRINT 中，将目标收缩压目标显著降低了主要 CVD 结局的风险[风险比 0.75（95%置信区间，0.58-0.98）；事件发生率 1.78 与 2.37%/年]。在 ACCORD BP 中，SBP 目标与主要 CVD 结局的关系受血糖目标干预的影响（交互 P=0.039）。在标准血糖亚组（A1c 目标 7-7.9%）中，强化 SBP 目标显著降低了主要 CVD 结局的风险[风险比 0.61（0.40-0.94）；事件发生率 1.63 与 2.56%/年]。在强化血糖亚组（A1c 目标<6%）中，两组之间主要 CVD 结局的风险无显著差异[风险比 1.20（0.76-1.89）；事件发生率 1.91 与 1.60%/年]。