Wang Chang, Liu Songyue, Miao Wei, Ye Ning, Xie Ziyi, Qiao Lixia, Ouyang Nanxiang, Yin Yangzhi, Sun Yingxian, Sun Guozhe
Department of Cardiology, The First Hospital of China Medical University, Shenyang, Liaoning 110001, China.
Lancet Reg Health West Pac. 2024 Jun 28;48:101127. doi: 10.1016/j.lanwpc.2024.101127. eCollection 2024 Jul.
The isolated systolic hypertension (ISH) is of high prevalence, with a relatively poor prognosis. However, there is still no direct evidence to demonstrate the benefits of intensive blood pressure (BP) control among these patients. We aimed to evaluate intensive BP control with the target of <130/80 mmHg in ISH.
This was a post hoc analysis of patients with ISH in the China Rural Hypertension Control Project (CRHCP), defined as systolic blood pressure (SBP) ≥ 140 mmHg and diastolic blood pressure (DBP) < 90 mmHg. The primary outcome was cardiovascular disease (CVD) including stroke, myocardial infarction, heart failure, and CVD death. Mixed-effect Cox proportional regression and generalized estimating equation models were used for analysis.
In total, 7981 patients were randomly assigned to the intervention group and 8005 to the usual care group between May 8 and November 27, 2018. The median follow-up was 3.02 years (25-75%: 2.98-3.06). Mean systolic/diastolic BP at the end of 36 months follow-up was 126.5/71.2 mmHg in the intensive BP control group and 148.1/78.6 mmHg in the usual care group. The intervention group presented a substantially lower rate of composite CVD compared with the usual care group (1.52% versus 2.30%/year; multiple-adjusted hazard ratio (HR): 0.64; 95% confidence interval (CI): 0.57-0.72; < 0.001), especially for stroke (multiple-adjusted HR: 0.61; 95% CI: 0.53-0.70; < 0.001), HF (multiple-adjusted HR: 0.57; 95% CI: 0.36-0.91; = 0.017) and CVD death (multiple-adjusted HR: 0.64; 95% CI: 0.50-0.83; < 0.001). The primary composite outcome was substantially reduced by 36% in the intervention group compared with the usual care group. The further interaction analysis revealed that the reduction of primary outcome by intervention was consistent across subgroups of sex, age, education level, history of CVD, use of antihypertensive medication and baseline DBP ( > 0.05 for all interaction test). The incidences of symptomatic hypotension, syncope injurious falls and renal outcomes did not differ between the two groups, even though hypotension was increased in intervention group (RR:1.71; 95% CI: 1.28-2.28; < 0.001).
Intensive BP control (<130/80 mmHg) was effective and safe in patients with ISH for the prevention of CVD events.
The Ministry of Science and Technology (China) of China and the Science and Technology Program of Liaoning Province, China.
单纯收缩期高血压（ISH）患病率高，预后相对较差。然而，仍无直接证据表明强化血压控制对这些患者有益。我们旨在评估以收缩压<130/80 mmHg为目标的强化血压控制对ISH患者的影响。
这是对中国农村高血压控制项目（CRHCP）中ISH患者的一项事后分析，ISH定义为收缩压（SBP）≥140 mmHg且舒张压（DBP）<90 mmHg。主要结局是心血管疾病（CVD），包括中风、心肌梗死、心力衰竭和CVD死亡。采用混合效应Cox比例回归模型和广义估计方程模型进行分析。
2018年5月8日至11月27日，共有7981例患者被随机分配至干预组，8005例患者被随机分配至常规治疗组。中位随访时间为3.02年（四分位数间距：2.98 - 3.06年）。随访36个月结束时，强化血压控制组的平均收缩压/舒张压为126.5/71.2 mmHg，常规治疗组为148.1/78.6 mmHg。与常规治疗组相比，干预组复合CVD发生率显著更低（1.52% 对2.30%/年；多因素调整风险比（HR）：0.64；95%置信区间（CI）：0.57 - 0.72；P<0.001），尤其是中风（多因素调整HR：0.61；95% CI：0.53 - 0.70；P<0.001）、心力衰竭（多因素调整HR：0.57；95% CI：0.36 - 0.91；P = 0.017）和CVD死亡（多因素调整HR：0.64；95% CI：0.50 - 0.83；P<0.001）。与常规治疗组相比，干预组主要复合结局显著降低了36%。进一步的交互分析显示，干预对主要结局的降低在性别、年龄、教育水平、CVD病史、使用降压药物和基线DBP等亚组中是一致的（所有交互检验P>0.05）。两组间症状性低血压、晕厥、跌倒致伤和肾脏结局的发生率无差异，尽管干预组低血压发生率有所增加（相对风险：1.71；95% CI：1.28 - 2.28；P<0.001）。
强化血压控制（<130/80 mmHg）对ISH患者预防CVD事件有效且安全。
中国科学技术部以及中国辽宁省科学技术项目。
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