Department of Cardiovascular Medicine, Second Xiangya Hospital, Central South University, Changsha 410011, China; Xiangya School of Medicine, Central South University, Changsha 410013, China.
Department of Cardiovascular Medicine, Second Xiangya Hospital, Central South University, Changsha 410011, China.
Maturitas. 2023 Jun;172:52-59. doi: 10.1016/j.maturitas.2023.04.009. Epub 2023 Apr 20.
To evaluate the effects of intensive treatment to lower blood pressure (BP) on the risk of cardiovascular disease (CVD) among patients aged over 60 years.
We extracted individual-level data of participants aged over 60 years from the SPRINT study and ACCORD study first, and then conducted a meta-analysis of major adverse cardiovascular events (MACEs) and other adverse events (hypotension and syncope) and renal outcomes across the SPRINT, STEP, ACCORD BP trials, which included 18,806 participants over 60 years of age. Participants were randomized to receive standard BP treatment or intensive BP treatment.
Hazard ratios (HRs) were used to calculate summary statistics.
In this meta-analysis, intensive treatment did not decrease either the all-cause mortality rate (HR: 0.98; 95 % confidence interval [CI]: 0.76-1.26; p = 0.87) or the cardiovascular mortality rate (HR: 0.77; 95 % CI: 0.54-1.08; p = 0.13). The incidence of MACEs (HR: 0.83; 95 % CI: 0.74-0.94; p = 0.003) and stroke (HR: 0.70; 95 % CI: 0.56-0.88; p = 0.002) was reduced, however. Intensive treatment had no effect on acute coronary syndrome (HR: 0.87; 95 % CI: 0.69-1.10; p = 0.24) or heart failure (HR: 0.70; 95 % CI: 0.40-1.22; p = 0.21). Intensive treatment increased the risk of hypotension (HR: 1.46; 95 % CI: 1.12-1.91; p = 0.006) and syncope (HR: 1.43; 95 % CI: 1.06-1.93; p = 0.02). Intensive treatment did not increase the risk of impaired kidney function among patients with chronic kidney disease (HR: 0.98; 95 % CI: 0.41-2.34; p = 0.96) or without chronic kidney disease (HR: 1.77; 95 % CI: 0.48-6.56; p = 0.40) at baseline.
Intensive BP goals reduced the incidence of MACEs and increased the risk of other adverse events without significant changes in mortality or renal outcome.
评估强化降压治疗对 60 岁以上患者发生心血管疾病（CVD）的影响。
我们首先从 SPRINT 研究和 ACCORD 研究中提取了 60 岁以上参与者的个体水平数据，然后对 SPRINT、STEP 和 ACCORD BP 试验中的主要不良心血管事件（MACE）和其他不良事件（低血压和晕厥）以及肾脏结局进行了荟萃分析，共纳入 18806 名 60 岁以上的参与者。参与者被随机分配接受标准血压治疗或强化血压治疗。
使用风险比（HRs）计算汇总统计数据。
在这项荟萃分析中，强化治疗并未降低全因死亡率（HR：0.98；95%置信区间[CI]：0.76-1.26；p=0.87）或心血管死亡率（HR：0.77；95%CI：0.54-1.08；p=0.13）。然而，MACEs（HR：0.83；95%CI：0.74-0.94；p=0.003）和中风（HR：0.70；95%CI：0.56-0.88；p=0.002）的发生率降低。强化治疗对急性冠状动脉综合征（HR：0.87；95%CI：0.69-1.10；p=0.24）或心力衰竭（HR：0.70；95%CI：0.40-1.22；p=0.21）没有影响。强化治疗增加了低血压（HR：1.46；95%CI：1.12-1.91；p=0.006）和晕厥（HR：1.43；95%CI：1.06-1.93；p=0.02）的风险。强化治疗并未增加慢性肾脏病患者（HR：0.98；95%CI：0.41-2.34；p=0.96）或无慢性肾脏病患者（HR：1.77；95%CI：0.48-6.56；p=0.40）肾功能受损的风险。
强化血压目标降低了 MACE 的发生率，并增加了其他不良事件的风险，但死亡率或肾脏结局没有显著变化。
