基线血清胆固醇与强化血压控制益处的关联。
Association of baseline serum cholesterol with benefits of intensive blood pressure control.
机构信息
Department of Cardiology, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100037, China.
Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong 510010, China.
出版信息
Chin Med J (Engl). 2023 Sep 5;136(17):2058-2065. doi: 10.1097/CM9.0000000000002474.
BACKGROUND
Intensive systolic blood pressure (SBP) control improved outcomes in the Strategy of Blood Pressure Intervention in the Elderly Hypertensive Patients (STEP) trial. Whether baseline serum lipid parameters influence the benefits of intensive SBP control is unclear.
METHODS
The STEP trial was a randomized controlled trial that compared the effects of intensive (SBP target of 110 to <130 mmHg) and standard (SBP target of 130 to <150 mmHg) SBP control in Chinese patients aged 60 to 80 years with hypertension. The primary outcome was a composite of cardiovascular disease events. A total of 8283 participants from the STEP study were included in this post hoc analysis to examine whether the effects of the SBP intervention differed by baseline low-density lipoprotein cholesterol (LDL-C) and non-high-density lipoprotein cholesterol (non-HDL-C) concentrations.
RESULTS
Regardless of the randomized SBP intervention, baseline LDL-C and non-HDL-C concentrations had a J-shaped association with the hazard of the primary outcome. However, the effects of the intensive SBP intervention on the primary outcome were not influenced by baseline LDL-C level ( P for interaction = 0.80) and non-HDL-C level ( P for interaction = 0.95). Adjusted subgroup analysis using tertiles in LDL-C1 (hazard ratio [HR], 0.77; 95% confidence interval [CI], 0.52-1.13; P = 0.18), LDL-C2 (HR, 0.81; 95% CI, 0.55-1.20; P = 0.29), and LDL-C3 (HR, 0.68; 95% CI, 0.47-0.98; P = 0.04) was provided, with an interaction P value of 0.49. Similar results were showed in non-HDL-C1 (HR, 0.87; 95% CI, 0.59-1.29; P = 0.49), non-HDL-C2 (HR, 0.70; 95% CI, 0.48-1.04; P = 0.08), and non-HDL-C3 (HR, 0.67; 95% CI, 0.47-0.95; P = 0.03), with an interaction P -value of 0.47.
CONCLUSION
High baseline serum LDL-C and non-HDL-C concentrations were associated with increased risk of primary cardiovascular disease outcome, but there was no evidence that the benefit of the intensive SBP control differed by baseline LDL-C and non-HDL-C concentrations.
CLINICAL TRIAL REGISTRATION
ClinicalTrials.gov, NCT03015311.
背景
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。目前尚不清楚基线血清脂质参数是否会影响强化 SBP 控制的获益。
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 目标为 110 至 <130mmHg）和标准（SBP 目标为 130 至 <150mmHg）SBP 控制的效果。主要终点是心血管疾病事件的综合指标。共有 8283 名来自 STEP 研究的参与者被纳入本事后分析，以检验 SBP 干预的效果是否因基线低密度脂蛋白胆固醇（LDL-C）和非高密度脂蛋白胆固醇（non-HDL-C）浓度的不同而有所差异。
结果
无论随机 SBP 干预如何，基线 LDL-C 和 non-HDL-C 浓度与主要终点事件的风险呈 J 形关联。然而，强化 SBP 干预对主要终点的影响不受基线 LDL-C 水平（交互 P 值=0.80）和非-HDL-C 水平（交互 P 值=0.95）的影响。使用 LDL-C1（危险比 [HR]，0.77；95%置信区间 [CI]，0.52-1.13；P=0.18）、LDL-C2（HR，0.81；95%CI，0.55-1.20；P=0.29）和 LDL-C3（HR，0.68；95%CI，0.47-0.98；P=0.04）的三分位数进行的调整亚组分析提供了交互 P 值为 0.49。在非-HDL-C1（HR，0.87；95%CI，0.59-1.29；P=0.49）、非-HDL-C2（HR，0.70；95%CI，0.48-1.04；P=0.08）和非-HDL-C3（HR，0.67；95%CI，0.47-0.95；P=0.03）中也得到了类似的结果，交互 P 值为 0.47。
结论
高基线血清 LDL-C 和 non-HDL-C 浓度与主要心血管疾病结局风险增加相关，但没有证据表明强化 SBP 控制的获益与基线 LDL-C 和 non-HDL-C 浓度有关。
临床试验注册
ClinicalTrials.gov，NCT03015311。
Zotero 插件