JAMA Intern Med:何时启动降压治疗获益很大?

2018-02-01 贾朝娟 环球医学

医疗界对启动降压治疗的最佳血压水平临界点仍在争论不休。针对这一争议,2018年1月发表在《JAMA Intern Med》的一项研究评估不同血压水平的降压治疗和与死亡及CVD之间的相关性,其研究结果或有利于早日定纷止争。

医疗界对启动降压治疗的最佳血压水平临界点仍在争论不休。针对这一争议,2018年1月发表在《JAMA Intern Med》的一项研究评估不同血压水平的降压治疗和与死亡及CVD之间的相关性,其研究结果或有利于早日定纷止争。

重要性高血压是全球死亡和心血管疾病(CVD)最重要的风险因素。启动高血压治疗的最佳临界点尚存争议。

目的:旨在评估不同血压水平的降压治疗和与死亡及CVD之间的相关性。

数据来源:从Pubmed、Cochrane系统回顾数据库、效果评价文摘数据库中鉴别出之前的系统评价。对这些评价的参考文献列表也进行了检索,检索内容为随机对照试验。2017年2月,研究者还检索了在Pubmed和Cochrane对照试验中心中2015年11月1日后发表的随机临床研究。

研究选择:具有至少1000患者-年的随访期且比较了降压药物vs安慰剂或不同降压目标的随机临床试验。

数据采集和分析:研究者从原始发表的研究中提取了数据。使用Cochrane协作评估工具评估了偏倚风险。用改良Knapp-Hartung随机效应Meta分析中汇总了相对风险(RR)。根据PRISMA指南报道结果。

主要结局和测量:预先定义的感兴趣的结局为全因死亡率、心血管死亡率、严重心血管事件、冠心病(CHD)、卒中心衰、终末期肾病。

结果:共有74项研究被纳入Meta分析中,代表了306273例参与者(女性39.9%,男性60.1%,平均63.6岁)和120万人年。在一级预防中,降压治疗与严重心血管事件的相关性取决于基线收缩压(SBP)。在基线SBP为160mmHg或以上的研究中,治疗与死亡风险的降低(RR,0.93;95% CI,0.87~1.00)和严重心血管事件的大幅降低(0.78;0.70~0.87)相关。如果基线SBP的范围为140~159mmHg,治疗与死亡之间的相关性相似(0.87;0.75~1.00),但是治疗与严重心血管事件之间的相关性较160mmHg以上不太明显(0.88;0.80~0.96)。在基线SBP低于140mmHg的试验中,治疗与死亡(0.98;0.90~1.06)以及严重心血管事件(0.97;0.90~1.04)不相关。在纳入了既往CHD和平均基线SBP为138mmHg的患者的试验中,治疗与严重心血管事件风险的降低相关(0.90;0.84~0.97),但是与生存不相关(0.98;0.89~1.07)。

结论和意义:若基线SBP为140mmHg或更高,则一级预防降压与死亡和CVD风险的降低相关。在较低的血压水平下,治疗与一级预防的任何获益都不相关,但是可为CHD患者提供额外的保护。

原始出处

Mattias Brunstrim and Bo Carlberg. Association of Blood Pressure Lowering With Mortality and Cardiovascular Disease Across Blood Pressure Levels. JAMA Intern Med. 2018;178(1):28-36. doi:10.1001/jamainternmed.2017.6015.

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    2018-02-27 Blank_

    学习了.

    0

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    2018-02-05 天涯183

    非常好的文章.学习了

    0

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    2018-02-02 120e71dcm28暂无昵称

    学习了

    0

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    2018-02-01 天涯183

    非常好的文章.学习了

    0

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    2018-02-01 1e0f8808m18(暂无匿称)

    早起动降血压治疗好

    0

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