Kostis William J, Cabrera Javier, Lin Chun Pang, Kostis John B, Wellings Jennifer, Zinonos Stavros, Dobrzynski Jeanne M, Blickstein Daniel
Cardiovascular Institute, Rutgers Robert Wood Johnson Medical School, New Brunswick, 08901, NJ, USA.
Department of Statistics, Rutgers University, Piscataway, 08854, NJ, USA.
Int J Cardiol Hypertens. 2020 Sep 19;7:100053. doi: 10.1016/j.ijchy.2020.100053. eCollection 2020 Dec.
The Systolic Blood Pressure Intervention Trial (SPRINT) was conducted in patients with hypertension and additional risk for cardiovascular disease who were randomized to the intensive blood pressure group targeting systolic blood pressure (SBP) less than 120 mm Hg and to the standard group where the target was less than 140 mm Hg. Analyses were done in the matched group of participants with the same gender, same age (±2 years) and same SBP (±3 mm Hg) at three months of treatment regardless of initial randomization to intensive or standard group (shaded area in Figure 1).
During 3.26 years of follow-up, intensive group participants had 14.8 mm Hg lower SBP and received on average one more (2.8 vs. 1.8) blood pressure lowering medications. This was associated with lower all-cause mortality in the intensive treatment group (hazard ratio, 0.73; 95% CI, 0.60 to 0.90, p = 0.003). The effect on SBP was achieved at 3 months and remained unchanged thereafter. This paper addresses two questions with respect to all-cause mortality in SPRINT in the matched set. 1) What is the effect of receiving more than one drug on all-cause mortality. Conditional logistic regression for all-cause mortality with respect to number of drugs indicated that during the 3.26 years of follow-up persons who received more than one drug were more likely to die (coefficient = 0.5039, OR = 1.6552, p = 0.0322) than patients who received one drug. 2) Was there a U curve relationship between on treatment SBP and all-cause mortality? A U curve fitting a quadratic equation (parabola) of SBP and all-cause death was observed. This was seen in the patients randomized to the standard target group in unadjusted analyses as well as in analyses adjusted for demographics or all covariates (p < 0.001 for all). The U curves in the combined group and the intensive treatment group were less pronounced.
SPRINT participants who were matched for gender, age, and SBP at 3 months, and received more than one drug had higher all-cause mortality during the 3.26 years of follow-up. Those who were randomized to standard treatment target had a U curve relationship between SBP at three months and all-cause mortality. The U curves in the combined group and the intensive treatment group were less pronounced.
收缩压干预试验（SPRINT）针对患有高血压且有心血管疾病额外风险的患者开展，这些患者被随机分为强化血压组，目标是收缩压（SBP）低于120 mmHg，以及标准组，目标是低于140 mmHg。在治疗三个月时，对性别相同、年龄相同（±2岁）且收缩压相同（±3 mmHg）的匹配参与者组进行分析，无论最初被随机分配到强化组还是标准组（图1中的阴影区域）。
在3.26年的随访期间，强化组参与者的收缩压降低了14.8 mmHg，平均多服用了一种（2.8种 vs. 1.8种）降压药物。这与强化治疗组较低的全因死亡率相关（风险比，0.73；95%置信区间为0.60至0.90，p = 0.003）。对收缩压的影响在3个月时实现，此后保持不变。本文针对匹配组中SPRINT试验的全因死亡率探讨了两个问题。1）服用不止一种药物对全因死亡率有何影响？关于药物数量的全因死亡率条件逻辑回归表明，在3.26年的随访期间，服用不止一种药物的人比服用一种药物的人更有可能死亡（系数 = 0.5039，OR = 1.6552, p = 0.0322））。2）治疗期间的收缩压与全因死亡率之间是否存在U型曲线关系？观察到收缩压与全因死亡之间拟合二次方程（抛物线）的U型曲线。在未调整分析以及根据人口统计学或所有协变量调整的分析中，随机分配到标准目标组中的患者均出现这种情况（所有p < 0.001）。联合组和强化治疗组中的U型曲线不太明显。
在3个月时按性别、年龄和收缩压匹配且服用不止一种药物的SPRINT参与者在3.26年的随访期间全因死亡率更高。那些被随机分配到标准治疗目标组的人在三个月时的收缩压与全因死亡率之间存在U型曲线关系。联合组和强化治疗组中的U型曲线不太明显。
