Alborzi Alireza, Attar Armin, Sayadi Mehrab, Nouri Fatemeh
Department of Cardiovascular Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
Student's Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran.
Cardiol Res Pract. 2021 May 11;2021:6635345. doi: 10.1155/2021/6635345. eCollection 2021.
There is still controversy about whether clinicians should include cardiovascular disease (CVD) risk stratification into the consideration for treatment of hypertension. This was a post hoc analysis of the Systolic Blood Pressure Intervention Trial (SPRINT). A total of 9361 nondiabetic patients without a history of stroke were randomly assigned to the intensive-treatment group (with an SBP target of <120 mm Hg) and the standard-treatment group (with an SBP target of <140 mm Hg). The patients were categorized into four groups based on the Atherosclerotic Cardiovascular Disease (ASCVD) risk score. The groups contained participants with ASCVD < 7.5%, 7.5% ≤ ASCVD <10%, 10% ≤ ASCVD < 15%, and ASCVD ≥ 15%. The incidence of the primary outcome, secondary outcome, and serious adverse events was compared between the two groups. The primary outcome was a composite of nonfatal myocardial infarction (MI), acute coronary syndrome (ACS) not resulting in MI, stroke, acute decompensated heart failure (HF), or death from cardiovascular causes. The secondary outcomes consisted of the individual components of the primary outcome and all-cause death. Intensive blood pressure (BP) control significantly reduced the incidence of primary outcome event in patients with 10% ≤ ASCVD < 15% (hazard ratio (HR) 0.593; 95% confidence interval (CI) 0.361-0.975; = 0.039) and ASCVD ≥ 15% (HR 0.778; CI 0.644-0.940; = 0.009). Intensive BP control was also beneficial for the primary prevention of cardiovascular events in patients with an ASCVD risk of 7.5-10% (HR 0.187; 95% CI 0.040-0.862; = 0.032). However, intensive treatment was associated with higher incidence of hypotension and acute renal failure in participants with ASCVD ≥ 15%. In patients without diabetes mellitus and prior stroke who had a 10-year risk of cardiovascular events above 10% based on the ASCVD risk score, intensive BP control played an important role in the reduction of major cardiovascular events. Additionally, intensive treatment would be beneficial for primary prevention in patients with ASCVD ≥ 7.5% without previous history of any cardiovascular disorders. Trial registration: ClinicalTrials.gov number; the trial is registered with NCT01206062.
临床医生是否应将心血管疾病（CVD）风险分层纳入高血压治疗的考量仍存在争议。这是一项对收缩压干预试验（SPRINT）的事后分析。共有9361例无糖尿病且无卒中病史的患者被随机分配至强化治疗组（收缩压目标<120 mmHg）和标准治疗组（收缩压目标<140 mmHg）。根据动脉粥样硬化性心血管疾病（ASCVD）风险评分将患者分为四组。这些组包含ASCVD<7.5%、7.5%≤ASCVD<10%、10%≤ASCVD<15%和ASCVD≥15%的参与者。比较两组的主要结局、次要结局和严重不良事件的发生率。主要结局是由非致命性心肌梗死（MI）、未导致MI的急性冠状动脉综合征（ACS）、卒中、急性失代偿性心力衰竭（HF）或心血管原因导致的死亡组成的复合结局。次要结局包括主要结局的各个组成部分和全因死亡。强化血压（BP）控制显著降低了ASCVD为10%≤ASCVD<15%的患者的主要结局事件发生率（风险比（HR）0.593；95%置信区间（CI）0.361 - 0.975；P = 0.039）以及ASCVD≥15%的患者的发生率（HR 0.778；CI 0.644 - 0.940；P = 0.009）。强化BP控制对ASCVD风险为7.5 - 10%的患者的心血管事件一级预防也有益（HR 0.187；95% CI 0.040 - 0.862；P = 0.032）。然而，强化治疗与ASCVD≥15%的参与者中低血压和急性肾衰竭的较高发生率相关。在基于ASCVD风险评分10年心血管事件风险高于10%的无糖尿病和既往卒中的患者中，强化BP控制在降低主要心血管事件方面发挥了重要作用。此外，强化治疗对无任何心血管疾病既往史且ASCVD≥7.5%的患者的一级预防有益。试验注册：ClinicalTrials.gov编号；该试验在NCT01206062注册。
