Li Na, Yang Zhixin, Yuan Quan, Cheng Wenli
Department of Health Care (Geriatrics), China-Japan Friendship Hospital, Ministry of Health, Beijing, China.
Department of Mathematical Sciences, Ball State University, Muncie, Indiana, USA.
J Clin Hypertens (Greenwich). 2025 Aug;27(8):e70098. doi: 10.1111/jch.70098.
Current hypertension guidelines lack personalized strategies for blood pressure control. While the Systolic Blood Pressure Intervention Trial (SPRINT) demonstrated benefits of intensive blood pressure lowering, identifying optimal candidates for such treatment remains challenging. We developed and validated a risk stratification model using data from 9139 SPRINT participants. The model incorporated 11 clinical variables through multivariable Cox regression analysis. Patients were stratified into low-, medium-, and high-risk groups. The study protocol was registered at ClinicalTrials.gov (NCT01206062). The model showed good discrimination with C-indices of 0.7354 (95% CI: 0.7065-0.7710) and 0.6894 (95% CI: 0.6545-0.7266) at 3 years for training and validation sets, respectively. Intensive treatment significantly reduced cardiovascular events in medium-risk (3.17% vs. 5.11%, p = 0.0376) and high-risk groups (9.34% vs. 11.86%, p = 0.0269), while showing a nonsignificant trend in the low-risk group (2.87% vs. 3.34%, p = 0.0870). The Rank-Weighted Average Treatment Effect analysis (16.06) supported potential benefits from individualized treatment allocation. No increased risk of severe adverse events was observed across risk groups. Our risk stratification model effectively identifies patients who derive significant cardiovascular benefits from intensive blood pressure lowering, particularly in medium- and high-risk groups. This approach could guide more personalized hypertension management strategies.
当前的高血压指南缺乏个性化的血压控制策略。虽然收缩压干预试验（SPRINT）证明了强化降压的益处，但确定此类治疗的最佳候选者仍然具有挑战性。我们利用来自9139名SPRINT参与者的数据开发并验证了一种风险分层模型。该模型通过多变量Cox回归分析纳入了11个临床变量。患者被分为低、中、高风险组。该研究方案已在ClinicalTrials.gov（NCT01206062）注册。该模型显示出良好的区分度，训练集和验证集在3年时的C指数分别为0.7354（95%CI：0.7065 - 0.7710）和0.6894（95%CI：0.6545 - 0.7266）。强化治疗在中风险组（3.17%对5.11%，p = 0.0376）和高风险组（9.34%对11.86%，p = 0.0269）中显著降低了心血管事件，而在低风险组中显示出不显著的趋势（2.87%对3.34%，p = 0.0870）。秩加权平均治疗效果分析（16.06）支持了个体化治疗分配的潜在益处。在各风险组中均未观察到严重不良事件风险增加。我们的风险分层模型有效地识别出了从强化降压中获得显著心血管益处的患者，特别是在中、高风险组中。这种方法可以指导更个性化的高血压管理策略。
