Dong Xilan, Ling Qianhui, Zhao Xueyan, Song Qirui, Cai Jun
Hypertension Center, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease of China, National Center for Cardiovascular Diseases of China, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (X.D., Q.S.).
Anzhen Hospital, Capital Medical University, Beijing, China (Q.L., J.C.).
Hypertension. 2025 Aug;82(8):1392-1400. doi: 10.1161/HYPERTENSIONAHA.125.25162. Epub 2025 Jun 26.
Current guidelines for blood pressure treatment are stratified by cardiovascular disease (CVD) risk levels. However, the impact of CVD risk on the benefits and harms of intensive blood pressure control remains unknown. This study aims to evaluate the cardiovascular benefits and treatment-related adverse events associated with intensive blood pressure control across different CVD risk levels.
From the STEP trial (Strategy of Blood Pressure Intervention in Older Hypertensive Patients), 8262 patients were stratified by tertiles of baseline 10-year CVD risk. Benefit and harm were determined as a reduction of primary outcomes and an increase of adverse events, respectively. Cox proportional hazard models were used to examine the association between CVD risk and outcome events in each tertile. The Poisson regression model was used to predict the benefits and harms.
During a median follow-up of 3.32 years, 333 primary outcomes and 611 adverse events occurred. Within each risk tertile, there were lower rates of the primary outcome in the intensive treatment group (overall hazard ratio, 0.76 [95% CI, 0.61-0.94]), and the hazard ratio for adverse events was 1.1 (95% CI, 0.94-1.28). Patients with higher CVD risk had higher absolute risk reduction of the primary outcome and absolute risk increase of adverse events. The predicted benefit-to-harm ratio differed significantly across each CVD risk tertile but favored intensive control overall.
Higher CVD risk was associated with increased benefit and harm from intensive blood pressure control. Although benefit and harm profiles varied across CVD risk levels, the overall benefit was greater than harm in all risk tertiles.
当前的血压治疗指南根据心血管疾病（CVD）风险水平进行分层。然而，CVD风险对强化血压控制的益处和危害的影响尚不清楚。本研究旨在评估不同CVD风险水平下强化血压控制相关的心血管益处和治疗相关不良事件。
从STEP试验（老年高血压患者血压干预策略）中，8262名患者按基线10年CVD风险三分位数进行分层。益处和危害分别确定为主要结局的降低和不良事件的增加。使用Cox比例风险模型检查每个三分位数中CVD风险与结局事件之间的关联。使用泊松回归模型预测益处和危害。
在中位随访3.32年期间，发生了333例主要结局和611例不良事件。在每个风险三分位数内，强化治疗组的主要结局发生率较低（总体风险比，0.76 [95% CI，0.61 - 0.94]），不良事件的风险比为1.1（95% CI，0.94 - 1.28）。CVD风险较高的患者主要结局的绝对风险降低和不良事件的绝对风险增加更高。每个CVD风险三分位数的预测利弊比差异显著，但总体上有利于强化控制。
较高的CVD风险与强化血压控制带来的益处增加和危害增加相关。尽管益处和危害情况因CVD风险水平而异，但在所有风险三分位数中总体益处大于危害。
