JACC:国际SPRINT试验:高血压患者收缩压控制时间与心血管结局的关系

2021-03-13 MedSci原创 MedSci原创

高血压患者血压监测不仅要关注血压值,同时也要关注血压控制在目标范围内的时间,后者可独立预测重大不良心血管事件风险。

随着医学进步,高血压阈值和关于高血压的主流观念已经发生变化。关于单纯舒张期高血压单纯收缩期高血压及联合收缩期和舒张期高血压所导致的后果,20世纪60年代出现了相关概念,当时流行的观点是只有舒张期高血压影响结局。

弗雷明汉(Framingham)心脏研究和其他研究表明,收缩期高血压作为血管结局的预测因素,其重要性实际上超过舒张期高血压,因此有人呼吁不再关注舒张压。因此美国心脏病学会/美国心脏学会(ACC/AHA)风险估计工具在确定心血管风险时也未考虑舒张压。

然而,去年发表在《新英格兰医学杂志》(NEJM)杂志上的一项重磅研究则为舒张压进行了正名研究对超过100万人、3600万次的血压测量数据显示,“上压”、“下压”都是心梗或中风发作风险的独立预测因素。2018年欧洲心脏病学会(ESC)高血压指南也建议所有风险水平患者的最佳舒张压目标为7080 mmHg

虽然收缩压和舒张压对心血管结局的影响都逐渐被证实,但标准的血压控制指标可能无法解释血压随时间的波动。因此,来自美国哈佛Brigham妇女医院等多个机构的心脏病学专家试图估计高血压患者收缩压时间波动与主要不良心血管事件之间的独立关联。结果发表在最新的《美国心脏病学会杂志》(JACC)上。

本研究是对SPRINT(收缩压干预试验)的事后分析,SPRINT是一项随机临床试验,比较了高血压和高心血管风险成人的强化(<120 mm Hg)和标准(<140 mm Hg)收缩压控制的结局差异。本研究将目标收缩压分别定义为强化组110130 mm Hg和标准组的120140 mm Hg

结果显示,将收缩压控制在目标范围内时间较长的患者往往更年轻,10年心血管风险较低,基线收缩压较低,且女性较多、他汀类药物使用率较高。在完全调整的模型中,将收缩压控制在目标范围内的时间每增加1-SD,与首次重大不良心血管事件的风险降低15%显著相关。

此外,尽管对平均收缩压或收缩压变异性进行了调整,但在目标范围内的时间长短仍与主要不良心血管事件显著相关。在平均收缩压达到或低于目标的参与者中,在目标范围内的时间仍与主要不良心血管事件相关。

综上,高血压患者血压监测不仅要关注血压值,同时也要关注血压控制在目标范围内的时间,后者可独立预测重大不良心血管事件风险。

 

参考文献:

Systolic Blood Pressure Time in Target Range and Cardiovascular Outcomes in Patients With Hypertension. J Am Coll Cardiol. 2021 Mar, 77 (10) 1290–1299.

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    2021-07-23 kalseyzl
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    2021-07-21 hbwxf
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    2021-03-14 ms1000001198102982

    很好好,泳涨矢知沿识了

    0

  8. [GetPortalCommentsPageByObjectIdResponse(id=1840363, encodeId=a2db18403630b, content=<a href='/topic/show?id=10905e20546' target=_blank style='color:#2F92EE;'>#收缩压#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=57205, encryptionId=10905e20546, topicName=收缩压)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4dfa37, createdName=huhuaidong387, createdTime=Tue Mar 16 23:47:35 CST 2021, time=2021-03-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1927546, encodeId=ba52192e5467c, content=<a href='/topic/show?id=5194166480e' target=_blank style='color:#2F92EE;'>#SPRINT#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=16648, encryptionId=5194166480e, topicName=SPRINT)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c77e138, createdName=kalseyzl, createdTime=Fri Jul 23 00:47:35 CST 2021, time=2021-07-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1854892, encodeId=254d1854892d6, content=<a href='/topic/show?id=48351020537' target=_blank style='color:#2F92EE;'>#JACC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=10205, encryptionId=48351020537, topicName=JACC)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=55ce62, createdName=hbwxf, createdTime=Wed Jul 21 21:47:35 CST 2021, time=2021-07-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1269378, encodeId=5eac12693e882, content=<a href='/topic/show?id=49d1518915a' target=_blank style='color:#2F92EE;'>#心血管结局#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=51891, encryptionId=49d1518915a, topicName=心血管结局)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7a9987, createdName=gous, createdTime=Mon Mar 15 10:47:35 CST 2021, time=2021-03-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1326747, encodeId=49b01326e4754, content=<a href='/topic/show?id=96c71804b7' target=_blank style='color:#2F92EE;'>#ACC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1804, encryptionId=96c71804b7, topicName=ACC)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1e452500029, createdName=12498568m50暂无昵称, createdTime=Mon Mar 15 10:47:35 CST 2021, time=2021-03-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1448329, encodeId=8dfc14483296e, content=<a href='/topic/show?id=5a9c102681f2' target=_blank style='color:#2F92EE;'>#高血压患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=102681, encryptionId=5a9c102681f2, topicName=高血压患者)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=b4665409655, createdName=维他命, createdTime=Mon Mar 15 10:47:35 CST 2021, time=2021-03-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=948098, encodeId=ce2f94809840, content=很好好,泳涨矢知沿识了, beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=4d425468165, createdName=ms1000001198102982, createdTime=Sun Mar 14 16:10:01 CST 2021, time=2021-03-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=947919, encodeId=ef8b94e919a8, content=学习了,涨知识了!, beContent=null, objectType=article, channel=null, level=null, likeNumber=79, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/ajNVdqHZLLDM9swhbgTo7nzqRKzMmzckmEoeTyLQVDCgjqsicjyhxPs0vPoYU6GsSYbCjSkNHicJkz3NL0a0EbUMVdNjkctXI6FocpGKaVr9E/0, createdBy=29392048316, createdName=ms2000001051330459, createdTime=Sat Mar 13 20:32:28 CST 2021, time=2021-03-13, status=1, ipAttribution=)]
    2021-03-13 ms2000001051330459

    学习了,涨知识了!

    0

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