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王继光教授谈SPRINT：再证强化降压预防卒中

2015-09-21 CMT 壹生

王继光教授SPRINT强化降压卒中
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        上海交通大学医学院附属瑞金医院 王继光教授 SPRINT试验因强化降压组(降压治疗目标120 mm Hg)的脑卒中与死亡风险显著低于标准降压组(降压治疗目标140 mm Hg) 而提前终止。该结果似乎与此前在糖尿病患者中进行的ACCORD试验结果大相径庭，因而受广泛到关注。 但事实可能是，SPRINT证实了ACCORD中

        
上海交通大学医学院附属瑞金医院 王继光教授

SPRINT试验因强化降压组(降压治疗目标120 mm Hg)的脑卒中与死亡风险显著低于标准降压组(降压治疗目标140 mm Hg) 而提前终止。该结果似乎与此前在糖尿病患者中进行的ACCORD试验结果大相径庭，因而受广泛到关注。

但事实可能是，SPRINT证实了ACCORD中强化降压预防脑卒中的结果。在ACCORD 试验中，强化治疗组治疗期间平均收缩压为119.3 mm Hg，比常规降压治疗组的同一指标(133.5 mm Hg)低14.2 mm Hg，脑卒中风险降低了41%。据目前了解到的SPRINT中强化治疗组脑卒中风险下降30%的数据，推测SPRINT中强化降压组与标准降压组的血压差别应略小于ACCORD试验，为10 mm Hg左右。由于2008年ACCORD试验结果的影响，加上2013年底JNC8指南调整了高血压启动治疗与目标血压，很可能SPRINT试验中强化降压治疗组的平均收缩压并未达到120 mm Hg的预定目标，而是在125~130 mm Hg左右，而常规治疗组达到了预定降压目标(约140 mm Hg)，两组血压相差约10 mm Hg。相应地，脑卒中风险下降30%，死亡风险降低了25%。

另一个可能显著影响结局，导致SPRINT总体结果与ACCORD不同的原因是研究对象的年龄。ACCORD入选受试者的年龄下限是40岁，平均年龄62岁;而SPRINT的年龄下限是50岁，75岁以上即便没有肾脏疾病或心血管疾病也可入选，因此入选人群的年龄可能高于ACCORD入选人群10岁左右，平均年龄可能为70~75岁。如果受试者平均年龄高于70岁，主要心脑血管并发症将是脑卒中，而非冠心病事件。ACCORD中常规降压治疗组脑卒中与冠心病事件的比例超过1:4(62/270)。如果SPRINT因为受试者年龄较大的原因，像LIFE试验一样，脑卒中事件数量超过心肌梗死事件，也就不难理解SPRINT与ACCORD结果的差异了。

这对我国高血压防治事业有很大启发。我国高血压患者的主要并发症是脑卒中，高龄患者更是如此。因此，亟需在我国高血压患者人群中进行类似设计的试验，观察强化血压管理是否显著降低中国高血压患者心脑血管并发症风险。

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    2016-04-17 fengxx

    #王继光#

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    2016-02-27 kalseyzl

    #SPRINT#

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    2016-05-29 ms920641618706883

    #王继光教授#

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    2015-09-23 经常头晕

    #降压#

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    2015-09-23 fengxx

    #强化降压#

    0