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JACC：强化降压治疗对于心血管疾病低危患者而言弊大于利

2018-03-17 佚名 嘉音

强化降压治疗心血管疾病CVD
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3月7日，在线发表于《JACC》杂志上的一项研究显示，对于基线时心血管疾病（CVD）风险较低的患者而言，强化降压治疗带来的危害要大于获益，而基线时CVD风险较高患者则可以获益更多。

3月7日，在线发表于《JACC》杂志上的一项研究显示，对于基线时心血管疾病（CVD）风险较低的患者而言，强化降压治疗带来的危害要大于获益，而基线时CVD风险较高患者则可以获益更多。

2017年，美国心脏协会和美国心脏病学会（AHA/ACC）及其他9个专业健康机构共同发布了新的高血压临床实践指南，这次指南更新中最引人瞩目的一点是高血压的诊断标准从140/90mmHg降至130/80mmHg。基于这一新标准，美国成年人群中有46%可以诊断为高血压，而采用旧标准时仅为32%。

然而，是否应单纯基于这一严格标准来进行强化降压治疗则仍存在争议。例如，虽然收缩压干预试验（SPRINT）中强化治疗组患者的主要终点事件发生率较低，但具有临床意义的严重不良事件（SAE）发生率也在显著增加。

在当前这项研究中，作者同样使用来自SPRINT试验的数据，并基于10年CVD风险评分对受试者进行分层，根据评分由低到高分为四个组（四分位数）。随后使用Cox比例风险评估模型评估了治疗组主要终点事件与SAE之间的相关性，并通过一个基于乘法泊松回归方程的预测模型来确定相应的获益-风险比（将CVD风险评分作为函数）。

结果显示，各个四分位数组中，强化治疗组中的主要终点事件发生率均更低，全因SAE发生率则无显著性差异。从第1组至第4组，预防1例主要终点事件所需治疗的患者数量从91例降至了38例，而发生1例SAE所需治疗的患者数量则从62例增加至250例。预测模型分析结果显示，第1组至第4组的患者接受强化降压治疗的获益-风险比依次显著增加（第1、2、3和4组患者分别为0.50±0.15、0.78±0.26、2.13±0.73和4.80±1.86，趋势P＜0.001）。

研究作者，来自美国休斯顿卫理公会医院的Robert Phillips教授指出：“尽管在美国实施更加严格的高血压治疗估计每年可以避免约107500例死亡病例，但这可能也会伴随着更多的SAE，使得临床医师及患者处于两难的境地。当前研究结果表明，基于患者未来的CVD风险对其进行分类，可能是识别出哪些患者是可以从强化降压治疗中获益最多的最佳方法。我们的模型分析发现，风险评分≥18.2的患者接受强化降压治疗得到的获益将大于可能存在的风险，而低于这一评分阈值的患者则仅需接受标准血压管理治疗。”

在该研究相应的述评中，来自美国康涅狄格大学医学院William B.White教授指出：“这项研究的结果非常重要，将有助于临床医师更好的管理高危高血压患者，尤其是老年患者。如果大家认同强化降压治疗会大幅增加急性肾损伤、低血压、晕厥和跌倒等SAE发生率的临床重要性与相对小幅降低心衰或心血管死亡风险的重要性相当，或许就不会针对第1组和第2组患者应用强化降压治疗方案来大幅降低其收缩压。”

原始出处：
Robert A. Phillips, et al. Impact of Cardiovascular Risk on the Relative Benefit and Harm of Intensive Treatment of Hypertension. Journal of the American College of Cardiology, Available online 7 March 2018.

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    2018-03-19 12498568m50暂无昵称

    #ACC#

    0

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    2018-03-19 xugumin

    #降压治疗#

    0

  5. [GetPortalCommentsPageByObjectIdResponse(id=1853968, encodeId=1b521853968c9, content=<a href='/topic/show?id=48351020537' target=_blank style='color:#2F92EE;'>#JACC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=21, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=10205, encryptionId=48351020537, topicName=JACC)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4dfa37, createdName=智者为医08, createdTime=Sun Jul 08 18:22:00 CST 2018, time=2018-07-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1291961, encodeId=759b129196196, content=<a href='/topic/show?id=9d32981418b' target=_blank style='color:#2F92EE;'>#降压#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=22, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=98141, encryptionId=9d32981418b, topicName=降压)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8f14236, createdName=经常头晕, createdTime=Mon Mar 19 09:22:00 CST 2018, time=2018-03-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1325763, encodeId=cacc1325e630c, content=<a href='/topic/show?id=96c71804b7' target=_blank style='color:#2F92EE;'>#ACC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, 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 19 09:22:00 CST 2018, time=2018-03-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1360871, encodeId=612113608e120, content=<a href='/topic/show?id=87fe98146d7' target=_blank style='color:#2F92EE;'>#降压治疗#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=23, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=98146, encryptionId=87fe98146d7, topicName=降压治疗)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=30bd35, createdName=xugumin, createdTime=Mon Mar 19 09:22:00 CST 2018, time=2018-03-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1419085, encodeId=12201419085fd, content=<a href='/topic/show?id=e051501461d' target=_blank style='color:#2F92EE;'>#强化降压#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=50146, encryptionId=e051501461d, topicName=强化降压)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=2c6c3470765, createdName=fengxx, createdTime=Mon Mar 19 09:22:00 CST 2018, time=2018-03-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1498388, encodeId=05ee149838881, content=<a href='/topic/show?id=bb6f89e145a' target=_blank style='color:#2F92EE;'>#血管疾病#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=89714, encryptionId=bb6f89e145a, topicName=血管疾病)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ccb99370406, createdName=andy2090, createdTime=Mon Mar 19 09:22:00 CST 2018, time=2018-03-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=297300, encodeId=753e29e30063, content=学习了受益匪浅, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/ajNVdqHZLLDicHg2ldsSNmib46PmdzpO7CQEmPjuULp1v45zPWwMYhrnXgvl3OtmUCZSQfgITWn96X9moL94nUGA/0, createdBy=28072041016, createdName=131****1460, createdTime=Sun Mar 18 07:25:10 CST 2018, time=2018-03-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=297192, encodeId=949829e19215, content=了解一下.谢谢分享!, beContent=null, objectType=article, channel=null, level=null, likeNumber=76, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cdnapi.center.medsci.cn/medsci/head/2019/12/23/2f51002e1349ccda5be11c1eea1e1e60.jpg, createdBy=a22097948, createdName=天地飞扬, createdTime=Sat Mar 17 23:08:05 CST 2018, time=2018-03-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=297170, encodeId=be2729e17095, content=3月7日.在线发表于<JACC>杂志上的一项研究显示.对于基线时心血管疾病(CVD)风险较低的患者而言.强化降压治疗带来的危害要大于获益.而基线时CVD风险较高患者则可以获益更多., beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7cJ6ejWUr2nIia8qOvAKNdLHr32Df6G8iaoaOx6pHaoiacwp26DaslxZHCGbibZhhCGven4rvmWP60GahtzgFjgCjR/0, createdBy=6b111703011, createdName=有备才能无患, createdTime=Sat Mar 17 21:37:18 CST 2018, time=2018-03-17, status=1, ipAttribution=)]
    2018-03-19 fengxx

    #强化降压#

    0

  6. [GetPortalCommentsPageByObjectIdResponse(id=1853968, encodeId=1b521853968c9, content=<a href='/topic/show?id=48351020537' target=_blank style='color:#2F92EE;'>#JACC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=21, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=10205, encryptionId=48351020537, topicName=JACC)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4dfa37, createdName=智者为医08, createdTime=Sun Jul 08 18:22:00 CST 2018, time=2018-07-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1291961, encodeId=759b129196196, content=<a href='/topic/show?id=9d32981418b' target=_blank style='color:#2F92EE;'>#降压#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=22, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=98141, encryptionId=9d32981418b, topicName=降压)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8f14236, createdName=经常头晕, createdTime=Mon Mar 19 09:22:00 CST 2018, time=2018-03-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1325763, encodeId=cacc1325e630c, content=<a href='/topic/show?id=96c71804b7' target=_blank style='color:#2F92EE;'>#ACC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, 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 19 09:22:00 CST 2018, time=2018-03-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1360871, encodeId=612113608e120, content=<a href='/topic/show?id=87fe98146d7' target=_blank style='color:#2F92EE;'>#降压治疗#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=23, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=98146, encryptionId=87fe98146d7, topicName=降压治疗)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=30bd35, createdName=xugumin, createdTime=Mon Mar 19 09:22:00 CST 2018, time=2018-03-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1419085, encodeId=12201419085fd, content=<a href='/topic/show?id=e051501461d' target=_blank style='color:#2F92EE;'>#强化降压#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=50146, encryptionId=e051501461d, topicName=强化降压)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=2c6c3470765, createdName=fengxx, createdTime=Mon Mar 19 09:22:00 CST 2018, time=2018-03-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1498388, encodeId=05ee149838881, content=<a href='/topic/show?id=bb6f89e145a' target=_blank style='color:#2F92EE;'>#血管疾病#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=89714, encryptionId=bb6f89e145a, topicName=血管疾病)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ccb99370406, createdName=andy2090, createdTime=Mon Mar 19 09:22:00 CST 2018, time=2018-03-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=297300, encodeId=753e29e30063, content=学习了受益匪浅, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/ajNVdqHZLLDicHg2ldsSNmib46PmdzpO7CQEmPjuULp1v45zPWwMYhrnXgvl3OtmUCZSQfgITWn96X9moL94nUGA/0, createdBy=28072041016, createdName=131****1460, createdTime=Sun Mar 18 07:25:10 CST 2018, time=2018-03-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=297192, encodeId=949829e19215, content=了解一下.谢谢分享!, beContent=null, objectType=article, channel=null, level=null, likeNumber=76, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cdnapi.center.medsci.cn/medsci/head/2019/12/23/2f51002e1349ccda5be11c1eea1e1e60.jpg, createdBy=a22097948, createdName=天地飞扬, createdTime=Sat Mar 17 23:08:05 CST 2018, time=2018-03-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=297170, encodeId=be2729e17095, content=3月7日.在线发表于<JACC>杂志上的一项研究显示.对于基线时心血管疾病(CVD)风险较低的患者而言.强化降压治疗带来的危害要大于获益.而基线时CVD风险较高患者则可以获益更多., beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7cJ6ejWUr2nIia8qOvAKNdLHr32Df6G8iaoaOx6pHaoiacwp26DaslxZHCGbibZhhCGven4rvmWP60GahtzgFjgCjR/0, createdBy=6b111703011, createdName=有备才能无患, createdTime=Sat Mar 17 21:37:18 CST 2018, time=2018-03-17, status=1, ipAttribution=)]
    2018-03-19 andy2090

    #血管疾病#

    0

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    2018-03-18 131****1460

    学习了受益匪浅

    0

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    2018-03-17 天地飞扬

    了解一下.谢谢分享!

    0

  9. [GetPortalCommentsPageByObjectIdResponse(id=1853968, encodeId=1b521853968c9, content=<a href='/topic/show?id=48351020537' target=_blank style='color:#2F92EE;'>#JACC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=21, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=10205, encryptionId=48351020537, topicName=JACC)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4dfa37, createdName=智者为医08, createdTime=Sun Jul 08 18:22:00 CST 2018, time=2018-07-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1291961, encodeId=759b129196196, content=<a href='/topic/show?id=9d32981418b' target=_blank style='color:#2F92EE;'>#降压#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=22, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=98141, encryptionId=9d32981418b, topicName=降压)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8f14236, createdName=经常头晕, createdTime=Mon Mar 19 09:22:00 CST 2018, time=2018-03-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1325763, encodeId=cacc1325e630c, content=<a href='/topic/show?id=96c71804b7' target=_blank style='color:#2F92EE;'>#ACC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, 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 19 09:22:00 CST 2018, time=2018-03-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1360871, encodeId=612113608e120, content=<a href='/topic/show?id=87fe98146d7' target=_blank style='color:#2F92EE;'>#降压治疗#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=23, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=98146, encryptionId=87fe98146d7, topicName=降压治疗)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=30bd35, createdName=xugumin, createdTime=Mon Mar 19 09:22:00 CST 2018, time=2018-03-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1419085, encodeId=12201419085fd, content=<a href='/topic/show?id=e051501461d' target=_blank style='color:#2F92EE;'>#强化降压#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=50146, encryptionId=e051501461d, topicName=强化降压)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=2c6c3470765, createdName=fengxx, createdTime=Mon Mar 19 09:22:00 CST 2018, time=2018-03-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1498388, encodeId=05ee149838881, content=<a href='/topic/show?id=bb6f89e145a' target=_blank style='color:#2F92EE;'>#血管疾病#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=89714, encryptionId=bb6f89e145a, topicName=血管疾病)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ccb99370406, createdName=andy2090, createdTime=Mon Mar 19 09:22:00 CST 2018, time=2018-03-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=297300, encodeId=753e29e30063, content=学习了受益匪浅, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/ajNVdqHZLLDicHg2ldsSNmib46PmdzpO7CQEmPjuULp1v45zPWwMYhrnXgvl3OtmUCZSQfgITWn96X9moL94nUGA/0, createdBy=28072041016, createdName=131****1460, createdTime=Sun Mar 18 07:25:10 CST 2018, time=2018-03-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=297192, encodeId=949829e19215, content=了解一下.谢谢分享!, beContent=null, objectType=article, channel=null, level=null, likeNumber=76, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cdnapi.center.medsci.cn/medsci/head/2019/12/23/2f51002e1349ccda5be11c1eea1e1e60.jpg, createdBy=a22097948, createdName=天地飞扬, createdTime=Sat Mar 17 23:08:05 CST 2018, time=2018-03-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=297170, encodeId=be2729e17095, content=3月7日.在线发表于<JACC>杂志上的一项研究显示.对于基线时心血管疾病(CVD)风险较低的患者而言.强化降压治疗带来的危害要大于获益.而基线时CVD风险较高患者则可以获益更多., beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7cJ6ejWUr2nIia8qOvAKNdLHr32Df6G8iaoaOx6pHaoiacwp26DaslxZHCGbibZhhCGven4rvmWP60GahtzgFjgCjR/0, createdBy=6b111703011, createdName=有备才能无患, createdTime=Sat Mar 17 21:37:18 CST 2018, time=2018-03-17, status=1, ipAttribution=)]
    2018-03-17 有备才能无患

    3月7日.在线发表于杂志上的一项研究显示.对于基线时心血管疾病(CVD)风险较低的患者而言.强化降压治疗带来的危害要大于获益.而基线时CVD风险较高患者则可以获益更多.

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