Is Blood Pressure Lowering in the Very Elderly With Previous Stroke Associated With a Higher Risk of Adverse Events?
Is Blood Pressure Lowering in the Very Elderly With Previous Stroke Associated With a Higher Risk of Adverse Events?
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DOI：
10.1161/jaha.121.022240
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发表时间：
2021-12-21
影响因子：
5.4
通讯作者：
Srikanth, Velandai
中科院分区：
文献类型：
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作者：
Tharmaratnam, Damien;Karayiannis, Christopher C.;Collyer, Taya A.;Arima, Hisatomi;McClure, Leslie A.;Chalmers, John;Anderson, Craig S.;Benavente, Oscar R.;White, Carole L.;Algra, Ale;Moran, Chris;Phan, Thanh G.;Wang, Wei C.;Srikanth, Velandai
我们调查了二级预防的血压降低是否与中风复发风险的降低和/或与年轻试验参与者相比，高龄患者的不良事件风险更高有关。这是对降低血压用于二级中风预防的随机对照试验的随机效应荟萃分析，以评估不良事件的年龄分层(<；80，≥80岁)风险。Ovid-MEDLINE在1970年至2020年期间被搜索进行试验。汇总水平的数据被获取，包括中风的结果、心血管事件、死亡率和不良事件。共纳入7个试验，共38,596人，其中2,336人(6.1%)年龄为≥80岁。与对照组相比，干预组的卒中风险总体降低(风险比[RR]，0.90[95%CI，0.80，0.98]，I2=49%)，风险降低的幅度没有年龄亚组的差异(<；80，≥80岁)。干预组80岁以上患者出现低血压症状的风险无增加(RR，1.19[95%CI，0.99]，1.44，I2=0%)，而≥80岁患者发生低血压症状的风险增加(RR，2.17[95%CI，1.22]，3.86，I2=0%)。在两个年龄组中，跌倒、晕厥、停止研究或跌倒的风险均未观察到增加。在降压的二级预防试验中，高龄人群低血压症状的风险增加，但摔倒、晕厥或死亡的风险没有统计学上的增加。然而，对于患有多种合并症的虚弱老年人缺乏证据，他们可能更容易受到降压不良影响的影响。
We investigated whether blood pressure lowering for secondary prevention is associated with a reduction in recurrent stroke risk and/or a higher risk of adverse events in very elderly compared with younger trial participants. This is a random effects meta‐analysis of randomized controlled trials of blood pressure lowering for secondary stroke prevention to evaluate age‐stratified (<80, ≥80 years) risk of adverse events. Ovid‐MEDLINE was searched for trials between 1970 and 2020. Summary‐level data were acquired including outcomes of stroke, cardiovascular events, mortality, and adverse events. Seven trials were included comprising 38 596 participants, of whom 2336 (6.1%) were aged ≥80 years. There was an overall reduction in stroke risk in the intervention group compared with controls (risk ratio [RR], 0.90 [95% CI, 0.80, 0.98], I2=49%), and the magnitude of risk reduction did not differ by age subgroup (<80, ≥80 years). There was no increase in the risk of hypotensive symptoms in the intervention group for patients aged <80 years (RR, 1.19 [95% CI, 0.99], 1.44, I2=0%), but there was an increased risk in those ≥80 years (RR, 2.17 [95% CI, 1.22], 3.86, I2=0%). No increase was observed in the risk of falls, syncope, study withdrawal, or falls in either age subgroup. Very elderly people in secondary prevention trials of blood pressure lowering have an increased risk of hypotensive symptoms, but with no statistical increase in the risk of falls, syncope, or mortality. However, evidence is lacking for frail elderly with multiple comorbidities who may be more vulnerable to adverse effects of blood pressure lowering.