Chen Linan, You Shoujiang, Ee Nicole, Rockwood Kenneth, Ward David D, Woodward Mark, Liu Tao, Gao Yijie, Williamson Jeff D, Anderson Craig S, Harris Katie, Chen Xiaoying, Peters Ruth
The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Newtown, Australia (L.C., S.Y., N.E., M.W., T.L., Y.G., C.S.A., K.H., X.C., R.P.).
Department of Neurology and Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, China (S.Y.).
Hypertension. 2025 Mar;82(3):509-519. doi: 10.1161/HYPERTENSIONAHA.124.24214. Epub 2025 Jan 14.
The association between systolic blood pressure and all-cause mortality differs between frail and nonfrail individuals, highlighting uncertainties about the effectiveness of antihypertensive treatments in frail populations.
Using data from the SHEP trial (Systolic Hypertension in the Elderly Program), a baseline frailty index (FI), including 55 variables, was constructed. Fine-Gray subdistribution hazard models and Cox proportional hazards regression models were used to explore the association between baseline FI and the risks of stroke, cardiovascular disease, and all-cause death, as well as to examine whether the impact of antihypertensive treatment on these outcomes was modified by baseline FI.
A total of 4692 participants (mean age, 72.1 years; 56.7% women) were included, with a mean (SD) FI of 0.134 (0.061). During a median follow-up period of 4.4 years, FI was associated with a higher risk of stroke (subdistribution hazard ratio, 1.24 [95% CI, 1.10-1.39]; per SD higher FI), cardiovascular disease (subdistribution hazard ratio, 1.18 [95% CI, 1.09-1.26]), and all-cause death (hazard ratio, 1.37 [95% CI, 1.26-1.50]), after adjustment for age, sex, race, education and treatment group. Although those with higher levels of frailty were at higher risk for all outcomes, there was no evidence of an interaction between baseline FI and antihypertensive treatment ( for interaction >0.05 for all outcomes).
In individuals with isolated systolic hypertension, antihypertensive treatment improved associated outcomes even among those with a higher degree of frailty. These findings from the SHEP trial reinforce evidence from other seminal antihypertensive trials, which collectively inform the appropriate treatment of frail individuals with hypertension.
URL: https://www.clinicaltrials.gov; Unique identifier: NCT00000514.
收缩压与全因死亡率之间的关联在虚弱个体和非虚弱个体中有所不同，这凸显了抗高血压治疗在虚弱人群中有效性的不确定性。
利用老年收缩期高血压计划（SHEP）试验的数据，构建了一个包含55个变量的基线虚弱指数（FI）。采用Fine-Gray亚分布风险模型和Cox比例风险回归模型，探讨基线FI与中风、心血管疾病和全因死亡风险之间的关联，并检验抗高血压治疗对这些结局的影响是否因基线FI而改变。
共纳入4692名参与者（平均年龄72.1岁；56.7%为女性），平均（标准差）FI为0.134（0.061）。在中位随访期4.4年期间，在调整年龄、性别、种族、教育程度和治疗组后，FI与中风风险较高相关（亚分布风险比，1.24[95%CI，1.10 - 1.39]；FI每升高一个标准差）、心血管疾病（亚分布风险比，1.18[95%CI，1.09 - 1.26]）和全因死亡（风险比，1.37[95%CI，1.26 - 1.50]）。尽管虚弱程度较高的人所有结局的风险都较高，但没有证据表明基线FI与抗高血压治疗之间存在相互作用（所有结局的相互作用P>0.05）。
在单纯收缩期高血压患者中，抗高血压治疗即使在虚弱程度较高的患者中也能改善相关结局。SHEP试验的这些发现强化了其他重要抗高血压试验的证据，这些证据共同为虚弱高血压患者的适当治疗提供了依据。
