Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia (J.E.S., P.O., P.R.-T.).
Endocrine Hypertension Research Centre, University of Queensland School of Medicine, Princess Alexandra Hospital, Brisbane, Australia (M.S.).
Hypertension. 2024 Jun;81(6):1400-1409. doi: 10.1161/HYPERTENSIONAHA.123.21653. Epub 2024 Apr 2.
Cuff blood pressure (BP) is recommended for guiding hypertension management. However, central BP has been proposed as a superior clinical measurement. This study aimed to determine whether controlling hypertension as measured by central BP was beneficial in reducing left ventricular mass index beyond control of standard cuff hypertension.
This multicenter, open-label, blinded-end point trial was conducted in individuals treated for uncomplicated hypertension with controlled cuff BP (<140/90 mm Hg) but elevated central BP (≥0.5 SD above age- and sex-specific normal values). Participants were randomized to 24-months intervention with spironolactone 25 mg/day (n=148) or usual care control (n=153). The primary outcome was change in left ventricular mass index measured by cardiac MRI. Cuff and central BPs were measured by clinic, 7-day home and 24-hour ambulatory BPs.
At 24-months, there was a greater reduction in left ventricular mass index (-3.2 [95% CI, -5.0 to -1.3] g/m; =0.001) with intervention compared with control. Cuff and central BPs were lowered by a similar magnitude across all BP measurement modes (eg, clinic cuff systolic BP, -6.16 [-9.60 to -2.72] mm Hg and clinic central systolic BP, -4.96 [-8.06 to -1.86] mm Hg; ≥0.48 all). Secondary analyses found that changes in left ventricular mass index correlated to changes in BP, with the magnitude of effect nearly identical for BP measured by cuff (eg, 24-hour systolic BP, β, 0.17 [0.02-0.31] g/m) or centrally (24-hour systolic BP, β, 0.16 [0.01-0.32] g/m).
Among individuals with central hypertension, spironolactone had beneficial effects in reducing LV mass. Secondary analyses showed that changes in LV mass were equally well associated with lower measured standard cuff BP and central BP.
URL: https://www.anzctr.org.au/; Unique identifier: ACTRN12613000053729.
cuff 血压（BP）被推荐用于指导高血压管理。然而，中心 BP 已被提出作为一种更优越的临床测量方法。本研究旨在确定控制中心 BP 所测量的高血压是否有益于在控制标准 cuff 高血压之外降低左心室质量指数。
这是一项多中心、开放标签、盲终点试验，在接受治疗的单纯高血压患者中进行，这些患者的 cuff BP（<140/90mmHg）得到控制，但中心 BP（高于年龄和性别特定正常值的 0.5 SD 以上）升高。参与者被随机分为 24 个月的干预组，每天服用螺内酯 25mg（n=148）或常规护理对照组（n=153）。主要结局是通过心脏 MRI 测量的左心室质量指数的变化。Cuff 和中心 BP 通过诊所、7 天家庭和 24 小时动态血压测量。
在 24 个月时，与对照组相比，干预组的左心室质量指数降低更多（-3.2[95%CI，-5.0 至-1.3]g/m；=0.001）。在所有 BP 测量模式下，Cuff 和中心 BP 均降低了相似的幅度（例如，诊所 cuff 收缩压，-6.16[-9.60 至-2.72]mmHg 和诊所中心收缩压，-4.96[-8.06 至-1.86]mmHg；≥0.48 所有）。二次分析发现，左心室质量指数的变化与 BP 的变化相关，BP 测量的效果大小几乎相同（例如，24 小时收缩压，β，0.17[0.02-0.31]g/m）或中心（24 小时收缩压，β，0.16[0.01-0.32]g/m）。
在中心高血压患者中，螺内酯对降低 LV 质量有有益的影响。二次分析表明，LV 质量的变化与较低的标准 cuff BP 和中心 BP 测量值同样相关。
