From the Department of Cardiology and Interventional Arrhythmology, Semey Medical University, Semey, Kazakhstan.
From the DLaboratory of Roentgen-endovascular Surgery, University Hospital of Semey Medical University, Semey, Kazakhstan.
Ann Saudi Med. 2020 May-Jun;40(3):234-254. doi: 10.5144/0256-4947.2020.234. Epub 2020 Jun 4.
The evidence for optimal blood pressure (BP) targets in Asian patients with hypertension is insufficient and controversial. Western guidelines should be used with caution in clinical practice until there is supporting evidence.
Systematically synthesize the evidence on the efficacy of achieving the strict 2018 European Society of Cardiology (ESC) guideline BP targets versus standard BP targets in Asian patients.
We searched PubMed, Web of Science, Scopus, the Cochrane Central Register of controlled trials, and additional databases to retrieve relevant Asian studies.
Randomized controlled trials (RCTs) and observational studies that reported clinical endpoints, had a minimal follow-up period of one year and included Asian patients older than 18 years with essential hypertension.
Two investigators independently conducted the study selection with any discrepancies resolved between team members.
We selected 15 studies for analysis (4 RCTs, 7 observational studies, and 4 post-hoc analyses). The evidence for the strict BP targets in elderly patients was insufficient. In middle-aged patients, the meta-analysis of observational studies revealed a significant reduction in major adverse cardiac events (MACCE) (hazard ratio (HR)=0.78; 95% confidence interval (CI: 0.74-0.81). For studies that reported results for patients of any age, the tight systolic BP-lowering therapy was associated with a decrease in MACCE (HR=0.80; 95% CI: 0.69-0.92), stroke (HR=0.82; 95% CI: 0.71-0.94), but not in cardiac events (HR=0.91; 95% CI: 0.72-1.14, =.41), all-cause (HR=0.80; 95% CI: 0.57-1.13) and cardiovascular mortality (HR=0.73; 95% CI: 0.40-1.33, =.30). Similar findings were obtained for the strict diastolic BP targets.
Our findings provide evidence for Asian patients that support the efficacy of the strict antihypertensive treatment with BP targets proposed by the 2018 ESC hypertension guidelines for the prevention of cardiovascular events. However, these data were obtained from only observational studies and the results were not confirmed by RCTs, probably due to insufficient power. Therefore, further high-quality RCTs are crucial.
Use of aggregated data, the subgroup and meta-regression analyses are inconclusive, limited to English language, unable to estimate summary measures for some outcomes, publication bias difficult to assess, and unclear that results could be extrapolated.
The protocol registered in PROSPERO (CRD42018115570).
None.
亚洲高血压患者的最佳血压（BP）目标证据不足且存在争议。在有支持证据之前，在临床实践中应谨慎使用西方指南。
系统综合评估严格遵循 2018 年欧洲心脏病学会（ESC）指南 BP 目标与标准 BP 目标在亚洲患者中的疗效证据。
我们检索了 PubMed、Web of Science、Scopus、Cochrane 对照试验中心注册库和其他数据库，以检索相关的亚洲研究。
纳入报告临床终点、随访时间至少 1 年且纳入年龄大于 18 岁的原发性高血压亚洲患者的随机对照试验（RCT）和观察性研究。
两名研究人员独立进行研究选择，团队成员之间存在任何分歧都将得到解决。
我们选择了 15 项研究进行分析（4 项 RCT、7 项观察性研究和 4 项事后分析）。关于老年患者严格 BP 目标的证据不足。在中年患者中，观察性研究的荟萃分析显示，主要不良心脏事件（MACCE）显著减少（风险比（HR）=0.78；95%置信区间（CI：0.74-0.81）。对于报告任何年龄患者结果的研究，严格的收缩压降低治疗与 MACCE 减少相关（HR=0.80；95%CI：0.69-0.92）、中风（HR=0.82；95%CI：0.71-0.94），但与心脏事件（HR=0.91；95%CI：0.72-1.14，=0.41）、全因（HR=0.80；95%CI：0.57-1.13）和心血管死亡率（HR=0.73；95%CI：0.40-1.33，=0.30）无关。严格的舒张压目标也有类似的发现。
我们的研究结果为亚洲患者提供了证据，支持严格降压治疗与 2018 ESC 高血压指南提出的 BP 目标预防心血管事件的疗效。然而，这些数据仅来自观察性研究，结果未被 RCT 证实，可能是因为效力不足。因此，进一步开展高质量的 RCT 至关重要。
使用汇总数据，亚组和荟萃回归分析结果不确定，仅限于英语，无法估计某些结局的汇总指标，难以评估发表偏倚，并且结果是否可以外推尚不清楚。
方案在 PROSPERO（CRD42018115570）中注册。
无。
