强化血压控制对顽固性高血压患者的影响：STEP试验的见解
Effect of Intensive Blood Pressure Control in Patients with Resistant Hypertension: Insights from the STEP Trial.
作者信息
Dong Xilan, Bai Jingjing, Ling Qianhui, Zhao Xueyan, Cai Jun
机构信息
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, 100037, China.
Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Chinese Institutes for Medical Research, Beijing, China.
出版信息
Eur J Prev Cardiol. 2025 Aug 12. doi: 10.1093/eurjpc/zwaf507.
AIMS
Resistant hypertension is defined as uncontrolled blood pressure (BP) despite the use of ≥3 antihypertensive drugs or controlled BP with ≥4 antihypertensive drugs. Whether intensive BP control is beneficial for the management of resistant hypertension is unknown.
METHODS
We compared intensive (<130 mmHg) to standard (130-150 mmHg) BP control in patients with resistant hypertension, using the Strategy of Blood Pressure Intervention in Older Hypertensive Patients (STEP) trial data. Patients were divided into those with and without resistant hypertension. The primary outcome was a composite of cardiovascular events. Hazard ratios (HR) were calculated using the Fine-Gray sub-distribution hazard model for primary and secondary events and the Cox regression model for all-cause death.
RESULTS
In patients with resistant hypertension, intensive BP control was associated with a lower risk of primary outcomes (HR, 0.36; 95% CI, 0.14-0.93, P = 0.035). Results were consistent across different BP thresholds used to define resistant hypertension and in patients with true resistant hypertension. The benefit of intensive BP control was consistent across resistant hypertension status. Intensive BP control was not associated with an increased risk of adverse events in patients with resistant hypertension. Patients with resistant hypertension had increased cardiovascular risk compared to those without (HR, 1.78; 95% CI, 1.13-2.81, P=0.012).
CONCLUSION
Intensive BP control is associated with reduced risk of cardiovascular events in patients with resistant hypertension without increased risk of adverse events.
CLINICAL TRIAL REGISTRATION
目的
顽固性高血压定义为尽管使用了≥3种抗高血压药物但血压仍未得到控制，或使用≥4种抗高血压药物血压才得到控制。强化血压控制对顽固性高血压的管理是否有益尚不清楚。
方法
我们使用老年高血压患者血压干预策略（STEP）试验数据，比较了顽固性高血压患者强化血压控制（<130 mmHg）与标准血压控制（130 - 150 mmHg）的效果。患者被分为有顽固性高血压和无顽固性高血压两组。主要结局是心血管事件的复合终点。使用Fine-Gray亚分布风险模型计算主要和次要事件的风险比（HR），使用Cox回归模型计算全因死亡的风险比。
结果
在顽固性高血压患者中，强化血压控制与较低的主要结局风险相关（HR，0.36；95%CI，0.14 - 0.93，P = 0.035）。在用于定义顽固性高血压的不同血压阈值以及真正的顽固性高血压患者中，结果一致。强化血压控制的益处与顽固性高血压状态无关。强化血压控制与顽固性高血压患者不良事件风险增加无关。与无顽固性高血压的患者相比，顽固性高血压患者的心血管风险增加（HR，1.78；95%CI，1.13 - 2.81，P = 0.012）。
结论
强化血压控制与顽固性高血压患者心血管事件风险降低相关，且不增加不良事件风险。
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