Lancet:伴有冠心病的高血压患者其血压应如何控制?

2016-08-30 MedSci MedSci原创

高血压的最佳血压目标仍然存在争议,特别是关于冠状动脉疾病,如果舒张压太低,对心肌的灌注会减少。本研究旨在探究冠状动脉疾病和高血压患者中血压和心血管结局之间的关系。 研究人员探究了22672名稳定型冠状动脉疾病和高血压的患者的数据。主要研究结果是心血管死亡,心肌梗死或中风的复合结果。多变量校正后的Cox比例风险模型估计危险比(HR),使用120–129 mm Hg的收缩压和70–79 mm H

高血压的最佳血压目标仍然存在争议,特别是关于冠状动脉疾病,如果舒张压太低,对心肌的灌注会减少。本研究旨在探究冠状动脉疾病和高血压患者中血压和心血管结局之间的关系。

研究人员探究了22672名稳定型冠状动脉疾病和高血压的患者的数据。主要研究结果是心血管死亡,心肌梗死或中风的复合结果。多变量校正后的Cox比例风险模型估计危险比(HR),使用120–129 mm Hg的收缩压和70–79 mm Hg的舒张压作为参考范围。

中位随访5年后,收缩压增加了≥140mm Hg,舒张压增加了≥80mm Hg,都与心血管事件的风险增加有关。收缩压<120 mm Hg也与主要研究结果风险的增加有关(校正后的HR 1.56,95% CI 1.36- 1.81)。同样,舒张压<70 mm Hg与的主要研究结果的增加有关(校正后舒张压60-69 mm Hg的HR 1.41[1.24-1.61],舒张压小于60 mm Hg 的HR2.01 [1.50-2.70 ])。

在高血压和冠状动脉疾病患者的常规护理中,收缩压<120 mm Hg,舒张压<70 mm Hg均与心血管不良事件的发生有关,包括死亡率,支持现在的J曲线现象。该研究发现表明,在冠状动脉疾病患者的降血压治疗中应采取谨慎态度。

原始出处:

Emmanuelle Vidal-Petiot, Ian Ford, et al., Cardiovascular event rates and mortality according to achieved systolic and diastolic blood pressure in patients with stable coronary artery disease: an international cohort study. The Lancet, August 30, 2016, DOI: http://dx.doi.org/10.1016/S0140-6736(16)31326-5.

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    2017-04-09 howi
  2. 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    2016-09-25 1e10c84am36(暂无匿称)

    文章很好值得关注

    0

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    2016-09-11 1e10c84am36(暂无匿称)

    己拜读,受益匪浅

    0

  4. 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attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160729/IMG579B144E006671125.jpg, createdBy=65e51929906, createdName=段医生, createdTime=Wed Aug 31 08:43:00 CST 2016, time=2016-08-31, status=1, ipAttribution=)]
    2016-09-11 1e10c84am36(暂无匿称)

    好文章,百姓也能从中学到好多医学知识

    0

  5. 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beContent=null, objectType=article, channel=null, level=null, likeNumber=74, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=5e291719269, createdName=大旺旺, createdTime=Wed Aug 31 14:44:00 CST 2016, time=2016-08-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=108028, encodeId=28fc10802836, content=这有些苛求。范围太仄。实际上没有谁能这么样控制, beContent=null, objectType=article, channel=null, level=null, likeNumber=46, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=01bb1684217, createdName=医张生, createdTime=Wed Aug 31 08:50:00 CST 2016, time=2016-08-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=107975, encodeId=919710e975a2, content=在冠状动脉疾病患者的降血压治疗中应采取谨慎态度。, beContent=null, objectType=article, channel=null, level=null, likeNumber=77, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160729/IMG579B144E006671125.jpg, createdBy=65e51929906, createdName=段医生, createdTime=Wed Aug 31 08:43:00 CST 2016, time=2016-08-31, status=1, ipAttribution=)]
    2016-09-06 李东泽

    很好,不错,以后会多学习

    0

  6. 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attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160729/IMG579B144E006671125.jpg, createdBy=65e51929906, createdName=段医生, createdTime=Wed Aug 31 08:43:00 CST 2016, time=2016-08-31, status=1, ipAttribution=)]
    2016-09-01 jyzxjiangqin

    积极干予高血压。

    0

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beContent=null, objectType=article, channel=null, level=null, likeNumber=74, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=5e291719269, createdName=大旺旺, createdTime=Wed Aug 31 14:44:00 CST 2016, time=2016-08-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=108028, encodeId=28fc10802836, content=这有些苛求。范围太仄。实际上没有谁能这么样控制, beContent=null, objectType=article, channel=null, level=null, likeNumber=46, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=01bb1684217, createdName=医张生, createdTime=Wed Aug 31 08:50:00 CST 2016, time=2016-08-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=107975, encodeId=919710e975a2, content=在冠状动脉疾病患者的降血压治疗中应采取谨慎态度。, beContent=null, objectType=article, channel=null, level=null, likeNumber=77, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160729/IMG579B144E006671125.jpg, createdBy=65e51929906, createdName=段医生, createdTime=Wed Aug 31 08:43:00 CST 2016, time=2016-08-31, status=1, ipAttribution=)]
  8. [GetPortalCommentsPageByObjectIdResponse(id=1828590, encodeId=c401182859082, content=<a href='/topic/show?id=1b6210686b2' target=_blank style='color:#2F92EE;'>#Lancet#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=47, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=10686, encryptionId=1b6210686b2, topicName=Lancet)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=3f0227, createdName=howi, createdTime=Sun Apr 09 12:27:00 CST 2017, time=2017-04-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=134785, encodeId=c08f134e85c8, content=文章很好值得关注, beContent=null, objectType=article, channel=null, level=null, likeNumber=94, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzdAIB7UwTkHt6fQkBP8ictliaXtc5gCUmYdAW1sAETC2nhO3q6YjRHkUibyOCtP8ibmXNObTyd63A076/0, createdBy=d4111948983, 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createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzdAIB7UwTkHt6fQkBP8ictliaXtc5gCUmYdAW1sAETC2nhO3q6YjRHkUibyOCtP8ibmXNObTyd63A076/0, createdBy=d4111948983, createdName=1e10c84am36(暂无匿称), createdTime=Sun Sep 11 08:05:00 CST 2016, time=2016-09-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=112427, encodeId=313311242e4b, content=很好,不错,以后会多学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=98, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzUn81b5CF5ibVPib8jWI92iciaxmqGHlwruOnK4SVZykd4iahqo1hicklIibyZoxm55X7EM8BW9eX1h1hQ2/0, createdBy=8aa81937526, createdName=李东泽, createdTime=Tue Sep 06 16:13:00 CST 2016, time=2016-09-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=109159, encodeId=a54a109159e5, content=积极干予高血压。, beContent=null, objectType=article, channel=null, level=null, 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beContent=null, objectType=article, channel=null, level=null, likeNumber=74, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=5e291719269, createdName=大旺旺, createdTime=Wed Aug 31 14:44:00 CST 2016, time=2016-08-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=108028, encodeId=28fc10802836, content=这有些苛求。范围太仄。实际上没有谁能这么样控制, beContent=null, objectType=article, channel=null, level=null, likeNumber=46, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=01bb1684217, createdName=医张生, createdTime=Wed Aug 31 08:50:00 CST 2016, time=2016-08-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=107975, encodeId=919710e975a2, content=在冠状动脉疾病患者的降血压治疗中应采取谨慎态度。, beContent=null, objectType=article, channel=null, level=null, likeNumber=77, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160729/IMG579B144E006671125.jpg, createdBy=65e51929906, createdName=段医生, createdTime=Wed Aug 31 08:43:00 CST 2016, time=2016-08-31, status=1, ipAttribution=)]
    2016-08-31 大旺旺

    学习了啊

    0

  9. 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beContent=null, objectType=article, channel=null, level=null, likeNumber=74, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=5e291719269, createdName=大旺旺, createdTime=Wed Aug 31 14:44:00 CST 2016, time=2016-08-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=108028, encodeId=28fc10802836, content=这有些苛求。范围太仄。实际上没有谁能这么样控制, beContent=null, objectType=article, channel=null, level=null, likeNumber=46, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=01bb1684217, createdName=医张生, createdTime=Wed Aug 31 08:50:00 CST 2016, time=2016-08-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=107975, encodeId=919710e975a2, content=在冠状动脉疾病患者的降血压治疗中应采取谨慎态度。, beContent=null, objectType=article, channel=null, level=null, likeNumber=77, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160729/IMG579B144E006671125.jpg, createdBy=65e51929906, createdName=段医生, createdTime=Wed Aug 31 08:43:00 CST 2016, time=2016-08-31, status=1, ipAttribution=)]
    2016-08-31 医张生

    这有些苛求。范围太仄。实际上没有谁能这么样控制

    0

  10. 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createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzdAIB7UwTkHt6fQkBP8ictliaXtc5gCUmYdAW1sAETC2nhO3q6YjRHkUibyOCtP8ibmXNObTyd63A076/0, createdBy=d4111948983, createdName=1e10c84am36(暂无匿称), createdTime=Sun Sep 11 08:05:00 CST 2016, time=2016-09-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=112427, encodeId=313311242e4b, content=很好,不错,以后会多学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=98, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzUn81b5CF5ibVPib8jWI92iciaxmqGHlwruOnK4SVZykd4iahqo1hicklIibyZoxm55X7EM8BW9eX1h1hQ2/0, createdBy=8aa81937526, createdName=李东泽, createdTime=Tue Sep 06 16:13:00 CST 2016, time=2016-09-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=109159, encodeId=a54a109159e5, content=积极干予高血压。, beContent=null, objectType=article, channel=null, level=null, 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beContent=null, objectType=article, channel=null, level=null, likeNumber=74, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=5e291719269, createdName=大旺旺, createdTime=Wed Aug 31 14:44:00 CST 2016, time=2016-08-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=108028, encodeId=28fc10802836, content=这有些苛求。范围太仄。实际上没有谁能这么样控制, beContent=null, objectType=article, channel=null, level=null, likeNumber=46, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=01bb1684217, createdName=医张生, createdTime=Wed Aug 31 08:50:00 CST 2016, time=2016-08-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=107975, encodeId=919710e975a2, content=在冠状动脉疾病患者的降血压治疗中应采取谨慎态度。, beContent=null, objectType=article, channel=null, level=null, likeNumber=77, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160729/IMG579B144E006671125.jpg, createdBy=65e51929906, createdName=段医生, createdTime=Wed Aug 31 08:43:00 CST 2016, time=2016-08-31, status=1, ipAttribution=)]
    2016-08-31 段医生

    在冠状动脉疾病患者的降血压治疗中应采取谨慎态度。

    0

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