血清尿酸与强化血压控制获益的关联。

Association of serum uric acid with benefits of intensive blood pressure control.

机构信息

Fu Wai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China.

Department of Cardiology, Peking Union Medical College Hospital, Peking, Union Medical College & Chinese Academy of Medical Sciences, Beijing, China.

出版信息

Rev Esp Cardiol (Engl Ed). 2023 Aug;76(8):635-644. doi: 10.1016/j.rec.2023.01.003. Epub 2023 Jan 28.

DOI:10.1016/j.rec.2023.01.003

PMID:36716991

Abstract

INTRODUCTION AND OBJECTIVES

Intensive systolic blood pressure (SBP) control improved outcomes in the Strategy of Blood Pressure Intervention in the Elderly Hypertensive Patients (STEP) trial. Whether the serum uric acid concentration at baseline alters the benefits of intensive SBP control is unknown.

METHODS

The STEP trial was a randomized controlled trial that compared the effects of intensive (SBP target of 110 to<130mmHg) and standard (SBP target of 130 to <150mmHg) SBP control in Chinese patients aged 60 to 80 years with hypertension. The primary outcome was a composite of cardiovascular disease events. This post hoc analysis was performed to examine whether the effects of intensive SBP intervention differed by the baseline uric acid concentration using 2 models: restricted cubic spline curves and subgroup analyses, both based on the Fine-Gray subdistribution hazard model in the analysis of the primary outcome and secondary outcomes (excluding all-cause death). In the analysis of all-cause death, the Cox regression model was used. We also examined the change in the follow-up uric acid concentrations.

RESULTS

Overall, the risk of the primary outcome rose as the cumulative uric acid concentration increased in both the intensive and standard treatment groups. Patients with intensive treatment had a lower multivariable-adjusted subdistribution hazard ratio for the primary outcome, but with a wide overlap of 95%CI. Next, we stratified patients according to their baseline uric acid concentration (tertile 1 [T1], <303.0μmol/L; tertile 2 [T2], 303.0 to <375.8μmol/L; and tertile 3 [T3], ≥375.8μmol/L). Subgroup analyses using tertiles provided HRs and 95%CI in T1 (HR, 0.55; 95%CI, 0.36-0.86; P=.008), T2 (HR, 0.80; 95%CI, 0.56-1.14; P=.22) and T3 (HR, 0.86; 95%CI, 0.60-1.21; P=.39), with an interaction P value of .29. The results for most of the secondary outcomes followed the same trends.

CONCLUSIONS

There was no evidence that the benefit of the intensive SBP control differed by baseline uric acid concentrations. This trial was registered at ClinicalTrial.gov (Identifier: NCT03015311).

摘要

简介和目的

强化收缩压（SBP）控制改善了老年高血压患者降压策略（STEP）试验的结果。目前尚不清楚基线时血清尿酸浓度是否会改变强化 SBP 控制的益处。

方法

STEP 试验是一项随机对照试验，比较了中国 60 至 80 岁高血压患者强化（SBP 目标值 110 至<130mmHg）和标准（SBP 目标值 130 至<150mmHg）SBP 控制的效果。主要结局是心血管疾病事件的综合指标。本事后分析使用两种模型（受限立方样条曲线和亚组分析），基于 Fine-Gray 亚分布风险模型，对初级和次要结局（不包括全因死亡）进行分析，以检查强化 SBP 干预的效果是否因基线尿酸浓度而异。在全因死亡分析中，使用 Cox 回归模型。我们还检查了随访尿酸浓度的变化。

结果

总的来说，在强化和标准治疗组，随着累积尿酸浓度的增加，主要结局的风险增加。与标准治疗组相比，强化治疗组患者的主要结局多变量调整后的亚分布风险比较低，但 95%CI 重叠较宽。接下来，我们根据患者的基线尿酸浓度（第 1 三分位数 [T1]，<303.0μmol/L；第 2 三分位数 [T2]，303.0 至<375.8μmol/L；第 3 三分位数 [T3]，≥375.8μmol/L）对患者进行分层。使用三分位数的亚组分析提供了 T1（HR，0.55；95%CI，0.36-0.86；P=.008）、T2（HR，0.80；95%CI，0.56-1.14；P=.22）和 T3（HR，0.86；95%CI，0.60-1.21；P=.39）的 HR 和 95%CI，交互 P 值为.29。大多数次要结局的结果也呈现出相同的趋势。