Lancet:血压控制与心血管事件

2017-04-06 MedSci MedSci原创

治疗期间平均SBP低于120 mmHg的患者发生除心肌梗死与卒中以外的心血管事件概率增大,治疗期间平均DBP低于70 mmHg的患者心肌梗死和入院心衰的风险增加

高血压治疗中,血压控制几何才健康?这对学术界而言是一个很大的挑战。研究人员近日提出假说:不同程度的低血压对某些方面有益,但对其他方面的损害。

在这项分析研究中,研究人员重新评估了ONTARGET以及TRANSCEND临床研究的数据(这2项研究中,参与者为55岁以上的具有心血管病史的患者,70%患有高血压,试验为期56个月,目的是研究替米沙坦、雷米普利及其组合制剂的疗效和安全性)。研究者分析了患者治疗后平均血压、治疗前血压基线、时间-血压曲线与心血管死亡、心肌梗死、卒中和心力衰竭入院等事件的关系。

在ONTARGET试验中 25127名对ACEI耐受的患者随机接受雷米普利10mg/天(n=8407), 替米沙坦80mg/天(n=8386)或者二者合剂(n=8334);在TRANSCEND试验中,5810名对ACEI耐受的患者随机接受替米沙坦80mg/天(n=2903)或安慰剂(n=2907)。研究发现治疗期间收缩压(SBP)140mmHg或更高的患者,较SBP120-140mmHg患者心血管事件发生的概率高。相反,基线舒张压(DBP)低于70 mmHg的患者,较DBP高于70 mmHg患者心血管事件发生的概率高。相比于治疗期间SBP120-140mmHg患者,4052名治疗期间SBP低于120 mmHg的患者,心血管事件发生率高(调整后的风险比 1.14,95% CI 1.03-1.26),心血管死亡率高(1.29,1.12-1.49),全因死亡率高(1.28,1.15-1.42),心肌梗死、卒中或住院心力衰竭方面无差异。相比于基线SBP和时间-血压SBP曲线,治疗后平均SBP能更好的预测患者结局而且治疗期间平均SBP在130mmHg的患者其心血管事件风险最低;相比于治疗期间平均DBP 70-80 mmHg的患者,治疗期间平均DBP低于70 mmHg的患者心血管事件的概率高(1.31,95% CI 1.20-1.42),心肌梗死概率高(1.55,1.36-1.86),全因死亡率升高(1.16,1.06-1.28),治疗期间平均DBP在75 mmHg的患者其心血管事件风险最低。

研究认为,治疗期间平均SBP低于120 mmHg的患者发生除心肌梗死与卒中以外的心血管事件概率增大,治疗期间平均DBP低于70 mmHg的患者心肌梗死和入院心衰的风险增加。因治疗导致的极低血压会增加多种心血管事件风险,一味的追求血压降低是不可取的。

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    2017-05-28 howi
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