Université de Lorraine, Centre d'Investigations Cliniques Plurithématique Inserm 1433, CHRU de Nancy Inserm U1116, FCRIN INI-CRCT, Nancy, France.
Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK.
Clin Cardiol. 2021 May;44(5):665-674. doi: 10.1002/clc.23591. Epub 2021 Apr 6.
Uncontrolled blood pressure (BP) increases the risk of major adverse cardiovascular events. In SPRINT an intensive versus standard BP lowering strategy resulted in a lower rate of cardiovascular events and death. Whether BP reduction only or also the choice of anti-hypertensive drugs is associated with outcomes remains to be elucidated.
We aim to study the association of BP and different anti-hypertensive drugs with several cardiovascular outcomes.
Time-updated Cox and mixed-effects models. The primary outcome was a composite of first myocardial infarction, acute coronary syndrome, stroke, heart failure, or cardiovascular death.
A total of 9361 patients were included. The anti-hypertensive agents most frequently used were ACEi/ARBs, with an almost 20% higher prescription rate in the intensive arm (80% vs. 61%), followed by thiazide-type diuretics (65% vs. 42%), calcium-channel blockers (57% vs. 39%), and beta-blockers (52% vs. 26%). Mineralocorticoid receptor antagonists were rarely used (≤7% of the observations). In multivariate analysis, the use of ACEi/ARBs, especially in combination with thiazides, were independently associated with a lower primary outcome event-rate (HR [95%CI] 0.75 [0.61-0.92], p = .006), whereas a DBP <60 mmHg was independently associated with a higher event-rate (HR [95%CI] 1.36 [1.07-1.71], p = .011). SBP <120 mmHg was associated with lower rate of cardiovascular and all-cause death on intensive treatment but not on the standard arm (interaction p < .05 for both).
In SPRINT, an intensive therapy strategy achieving SBP <120 mmHg with a DBP ≥60 mmHg, and using ACEi/ARBs plus thiazides was associated with a lower event-rate.
未控制的血压（BP）会增加主要不良心血管事件的风险。在 SPRINT 中，强化降压策略与标准降压策略相比，降低了心血管事件和死亡的发生率。降低血压仅与抗高血压药物的选择有关，还是与结果有关，这一点仍有待阐明。
我们旨在研究 BP 和不同抗高血压药物与多种心血管结局的关系。
时间更新的 Cox 和混合效应模型。主要结局是首次心肌梗死、急性冠脉综合征、卒中和心力衰竭或心血管死亡的复合结局。
共纳入 9361 例患者。最常用的抗高血压药物是 ACEi/ARB，强化组的处方率几乎高出 20%（80% vs. 61%），其次是噻嗪类利尿剂（65% vs. 42%）、钙通道阻滞剂（57% vs. 39%）和β受体阻滞剂（52% vs. 26%）。很少使用盐皮质激素受体拮抗剂（≤7%的观察结果）。在多变量分析中，ACEi/ARB 的使用，尤其是与噻嗪类药物联合使用，与较低的主要结局事件发生率独立相关（HR [95%CI] 0.75 [0.61-0.92]，p =.006），而 DBP <60mmHg 与更高的事件发生率独立相关（HR [95%CI] 1.36 [1.07-1.71]，p =.011）。在强化治疗中，SBP <120mmHg 与较低的心血管和全因死亡率相关，但在标准治疗组中没有（两者的交互作用 p <.05）。
在 SPRINT 中，采用 SBP <120mmHg、DBP ≥60mmHg 的强化治疗策略，并使用 ACEi/ARB 加噻嗪类药物，可降低事件发生率。
