血压处于目标范围内的时间与不良健康结局：一项系统评价
Time in Target Range for Blood Pressure and Adverse Health Outcomes: A Systematic Review.
作者信息
Wang Huairong, Song Jialu, Liu Zhike, Yu Huan, Wang Kun, Qin Xueying, Wu Yiqun
机构信息
Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China (H.W., J.S., Z.L., H.Y., K.W., X.Q., Y.W.).
Key Laboratory of Epidemiology of Major Diseases, Peking University, Ministry of Education, Beijing, China (Z.L., X.Q., Y.W.).
出版信息
Hypertension. 2025 Mar;82(3):419-431. doi: 10.1161/HYPERTENSIONAHA.124.24013. Epub 2025 Jan 13.
BACKGROUND
Blood pressure (BP) time in target range (TTR) reflects the proportion of time that BP measurement is within a specified target range. We aim to summarize the evidence for relationships between TTR and adverse health outcomes.
METHODS
Seven databases were searched. After quality assessment and data extraction, meta-analyses were performed to generate pooled estimates of the association (hazard ratios) between TTR and health outcomes. Primary outcomes were all-cause mortality and cardiovascular death. Secondary outcomes included major adverse cardiovascular events, myocardial infarction, stroke, heart failure, atrial fibrillation, and adverse kidney events.
RESULTS
In all, 21 studies were included, mostly rated at low risk of bias. TTR was defined by systolic BP (SBP) in 15 studies and by both SBP and diastolic BP in 6 studies. Per SD increase of TTR was associated with significantly decreased risks of all-cause mortality (110-130 mm Hg SBP TTR: hazard ratios, 0.85 [95% CI, 0.82-0.89]; 120-140 mm Hg SBP TTR: 0.81 [95% CI, 0.70-0.94]; and 70-80 mm Hg diastolic BP TTR: 0.88 [95% CI, 0.83-0.93]), cardiovascular death (110-130 mm Hg SBP TTR: 0.83 [95% CI, 0.78-0.87]; 120-140 mm Hg SBP TTR: 0.76 [95% CI, 0.65-0.89]; and 70-80 mm Hg diastolic BP TTR: 0.85 [95% CI, 0.80-0.90]), major adverse cardiovascular events (120-140 mm Hg SBP TTR: 0.76 [95% CI, 0.70-0.83]), and heart failure (110-130 mm Hg SBP TTR: 0.84 [95% CI, 0.76-0.93] and 120-140 mm Hg SBP TTR: 0.78 [95% CI, 0.68-0.89]). However, there was not sufficient support for the association of TTR with myocardial infarction, stroke, atrial fibrillation, or adverse kidney events.
CONCLUSIONS
Higher TTR was associated with reduced risks of all-cause mortality, cardiovascular death, major adverse cardiovascular events, and heart failure, highlighting the importance of sustained BP control in clinical practice.
REGISTRATION
URL: https://www.crd.york.ac.uk/PROSPERO/; Unique identifier: CRD42023486437.
背景
血压处于目标范围内的时间（TTR）反映了血压测量值处于指定目标范围内的时间比例。我们旨在总结TTR与不良健康结局之间关系的证据。
方法
检索了七个数据库。在进行质量评估和数据提取后，进行荟萃分析以生成TTR与健康结局之间关联（风险比）的汇总估计值。主要结局为全因死亡率和心血管死亡。次要结局包括主要不良心血管事件、心肌梗死、中风、心力衰竭、心房颤动和不良肾脏事件。
结果
总共纳入了21项研究，大多数研究的偏倚风险较低。15项研究通过收缩压（SBP）定义TTR，6项研究通过SBP和舒张压定义TTR。TTR每增加一个标准差，全因死亡率风险显著降低（SBP为110 - 130 mmHg时的TTR：风险比，0.85 [95% CI，0.82 - 0.89]；SBP为120 - 140 mmHg时的TTR：0.81 [95% CI，0.70 - 0.94]；舒张压为70 - 80 mmHg时的TTR：0.88 [95% CI，0.83 - 0.93]），心血管死亡风险降低（SBP为110 - 130 mmHg时的TTR：0.83 [95% CI，0.78 - 0.87]；SBP为120 - 140 mmHg时的TTR：0.76 [95% CI，0.65 - 0.89]；舒张压为70 - 80 mmHg时的TTR：0.85 [95% CI，0.80 - 0.90]），主要不良心血管事件风险降低（SBP为120 - 140 mmHg时的TTR：0.76 [95% CI，0.70 - 0.83]），心力衰竭风险降低（SBP为110 - 130 mmHg时的TTR：0.84 [95% CI，0.76 - 0.93]，SBP为120 - 140 mmHg时的TTR：0.78 [95% CI，0.68 - 0.89]）。然而，没有足够证据支持TTR与心肌梗死、中风、心房颤动或不良肾脏事件之间的关联。
结论
较高的TTR与全因死亡率、心血管死亡、主要不良心血管事件和心力衰竭风险降低相关，凸显了临床实践中持续血压控制的重要性。
注册信息
网址：https://www.crd.york.ac.uk/PROSPERO/；唯一标识符：CRD42023486437
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