Randomized Controlled Trials of Blood Pressure Lowering in Hypertension A Critical Reappraisal
Randomized Controlled Trials of Blood Pressure Lowering in Hypertension A Critical Reappraisal
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DOI：
10.1161/circresaha.116.303641
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发表时间：
2015-03-13
影响因子：
20.1
通讯作者：
Parati, Gianfranco
中科院分区：
文献类型：
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作者：
Zanchetti, Alberto;Thomopoulos, Costas;Parati, Gianfranco
66项降低血压的随机对照试验(定义为随机对照试验，比较积极治疗与安慰剂，或不太积极的治疗，实现血压差异，在1966年至2013年底期间，在>= 40%的高血压患者队列中进行，不包括急性心肌梗死，心力衰竭，急性中风，(1)血压降低是否能降低所有类型的心血管结局？(2)所有结局的预防是否与收缩压、舒张压和脉搏血压成正比？(3)是否所有类型的降血压药物都被证明能够降低所有类型的心血管结局？(4)在高血压的任何级别（或阶段）开始干预降压是否有益？(5)降压随机对照试验是否提供了收缩压和舒张压治疗目标的证据？(6)降压治疗是否应该优先针对有更大绝对治疗效益的高风险患者？这些荟萃分析的结果为当前的高血压治疗指南提供了进一步的支持，表明降低血压可以显著降低主要心血管结局，这在很大程度上与所使用的药物无关，所有高血压等级（阶段）都有显著的风险降低，当收缩压降至140毫米汞柱以下时，进一步的降低仅限于收缩压值下的中风
Sixty-eight blood pressure (BP)-lowering randomized controlled trials (defined as randomized controlled trials comparing active treatment with placebo, or less active treatment, achieving a BP difference, performed between 1966 and end 2013 in cohorts with >= 40% hypertensive patients, and exclusive of trials in acute myocardial infarction, heart failure, acute stroke, and dialysis) were identified and meta-analyzed grouping the randomized controlled trials on the basis of clinically relevant questions: (1) does BP lowering reduce all types of cardiovascular outcome? (2) Is prevention of all outcomes proportional to the extent of systolic, diastolic, and pulse BP? (3) Have all classes of BP-lowering drugs been shown capable of reducing all types of cardiovascular outcome? (4) Is BP lowering beneficial when intervention is initiated at any grade (or stage) of hypertension? (5) Do BP-lowering randomized controlled trials provide evidence about systolic BP and diastolic BP targets of treatment? (6) Should BP-lowering treatment be preferentially addressed to patients in higher risk categories promising larger absolute treatment benefits? The results of these meta-analyses provide further support to current hypertension treatment guidelines by showing that BP lowering can significantly reduce major cardiovascular outcomes largely independent of the agents used, significant risk reduction is found at all hypertension grades (stages), and when systolic BP is lowered below a cut off of 140 mm Hg with some further reduction limited to stroke at systolic BP values just