Department of Cardiology, Anzhen Hospital, Capital Medical University, Beijing, China (W.L., Z.W., C.J., C.H., Y.T., H.Z., X.L., S.Z., Y.W., M.G., Q.L., J.D., C.M., X.D.).
Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Henan Province, China (J.D.).
Hypertension. 2024 Mar;81(3):620-628. doi: 10.1161/HYPERTENSIONAHA.123.22194. Epub 2024 Jan 2.
To evaluate whether cancer modifies the effect of intensive blood pressure control on major cardiovascular outcomes.
Using data of the SPRINT (Systolic Blood Pressure Intervention Trial), we compared the risk of the composite outcomes of myocardial infarction, other acute coronary syndromes, stroke, heart failure, and cardiovascular death in patients with and without a history of cancer. Using Cox proportional hazards regression, we tested interactions between history of cancer and intensive blood pressure control on major cardiovascular outcomes.
The study included a total of 9336 patients, with a mean age of 67.9±9.4 years, among whom 2066 (22.2%) were cancer survivors. Over a median follow-up of 3.2 years, 561 primary cardiovascular outcomes were observed. Cancer survivors had a similar risk of experiencing the primary outcome compared with patients without cancer after multivariable adjustment (adjusted hazard ratio, 0.94 [95% CI, 0.77-1.15]). Intensive blood pressure control reduced risk of the primary cardiovascular outcome similarly for cancer survivors (hazard ratio, 0.70 [95% CI, 0.51-0.97]) and patients without cancer (HR, 0.76 [95% CI, 0.63-0.93]; for interaction 0.74).
In SPRINT study, intensive blood pressure treatment reduced the risk of major cardiovascular events in cancer survivors to a similar extent to that of patients without cancer. Cancer history not requiring active treatment in last 2 years should not be an obstacle to intensive treatment of hypertension. This post hoc analysis should be considered as hypothesis-generating and merit further clinical trial.
URL: https://www.clinicaltrials.gov; Unique identifier: NCT01206062.
评估癌症是否改变强化血压控制对主要心血管结局的影响。
利用 SPRINT（收缩压干预试验）的数据，我们比较了有和无癌症病史患者心肌梗死、其他急性冠脉综合征、卒中等主要心血管结局复合事件的风险。采用 Cox 比例风险回归，我们检验了癌症病史与强化血压控制对主要心血管结局的交互作用。
研究共纳入 9336 例患者，平均年龄 67.9±9.4 岁，其中 2066 例（22.2%）为癌症幸存者。中位随访 3.2 年后，观察到 561 例主要心血管结局。多变量调整后，癌症幸存者发生主要结局的风险与无癌症患者相似（校正后 HR，0.94 [95%CI，0.77-1.15]）。强化血压控制同样降低了癌症幸存者（HR，0.70 [95%CI，0.51-0.97]）和无癌症患者（HR，0.76 [95%CI，0.63-0.93]）发生主要心血管结局的风险；交互检验 P 值为 0.74）。
在 SPRINT 研究中，强化血压治疗降低了癌症幸存者主要心血管事件的风险，与无癌症患者的降低程度相似。在过去 2 年内无需积极治疗的癌症病史不应成为强化高血压治疗的障碍。本事后分析应视为假设生成，并值得进一步临床试验验证。
