Hypertension Center, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China (R.Y., J.C.).
Department of Cardiology, the First Affiliated Hospital of Guangxi Medical University, Nanning, China (R.H.).
Hypertension. 2023 Dec;80(12):2572-2580. doi: 10.1161/HYPERTENSIONAHA.123.21892. Epub 2023 Oct 10.
The STEP (Strategy of Blood Pressure Intervention in the Elderly Hypertensive Patients) trial demonstrated that intensive systolic blood pressure (SBP) lowering has cardiovascular benefits. However, the influence of baseline diastolic blood pressure (DBP) on the effects of intensive blood pressure lowering on cardiovascular outcomes has not been fully elucidated.
We performed a post hoc analysis of the STEP trial. Participants were randomly allocated to intensive (110 to <130 mm Hg) or standard (130 to <150 mm Hg) treatment groups. The effects of intensive SBP lowering on the primary composite outcome (stroke, acute coronary syndrome, acute decompensated heart failure, coronary revascularization, atrial fibrillation, and cardiovascular death), major adverse cardiac event (a composite of the individual components of the primary outcome except for stroke), and all-cause mortality were analyzed according to baseline DBP as both a categorical and a continuous variable.
The 8259 participants had a mean age of 66.2±4.8 years, and 46.5% were men. Participants with lower DBP were slightly older and had greater histories of cardiovascular disease, diabetes, and hyperlipidemia. Within each baseline DBP quartile, the mean achieved DBP was lower in the intensive versus standard group. The effects of intensive SBP lowering were not modified by baseline DBP as a continuous variable or as a categorical variable (quartiles, or <70, 70 to <80, and ≥80 mm Hg; all value for interaction >0.05).
The beneficial effects of intensive SBP lowering on cardiovascular outcomes were unaffected by baseline DBP. Lower DBP should not be an obstacle to intensive SBP control.
URL: https://www.clinicaltrials.gov; Unique identifier: NCT03015311.
STEP（老年高血压患者血压干预策略）试验表明，强化收缩压（SBP）降低具有心血管益处。然而，基线舒张压（DBP）对强化降压对心血管结局影响的影响尚未完全阐明。
我们对 STEP 试验进行了事后分析。参与者被随机分配到强化（110 至<130mmHg）或标准（130 至<150mmHg）治疗组。根据基线 DBP 作为分类和连续变量，分析强化 SBP 降低对主要复合结局（中风、急性冠状动脉综合征、急性失代偿性心力衰竭、冠状动脉血运重建、心房颤动和心血管死亡）、主要不良心脏事件（除中风外，主要结局的各个组成部分的复合）和全因死亡率的影响。
8259 名参与者的平均年龄为 66.2±4.8 岁，46.5%为男性。DBP 较低的参与者年龄稍大，且有更多的心血管疾病、糖尿病和高脂血症病史。在每个基线 DBP 四分位区间内，强化组的平均实际 DBP 低于标准组。强化 SBP 降低的效果不受基线 DBP 作为连续变量或分类变量的影响（四分位数或<70、70 至<80 和≥80mmHg；所有交互 值>0.05）。
强化 SBP 降低对心血管结局的有益影响不受基线 DBP 的影响。较低的 DBP 不应成为强化 SBP 控制的障碍。
