Blood pressure and stroke - An overview of published reviews
Blood pressure and stroke - An overview of published reviews
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DOI：
10.1161/01.str.0000116869.64771.5a
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发表时间：
2004-03-01
期刊：
影响因子：
8.3
通讯作者：
Rodgers, A
中科院分区：
文献类型：
--
作者：
Lawes, CMM;Bennett, DA;Rodgers, A
背景——过去几年，有关血压 (BP) 和中风关联的可用信息量显着增加。本文概述了已发表的关于降压药物试验中对中风影响的评论，并将其与队列研究的结果进行比较。评论摘要 - 我们对前瞻性队列研究的主要概述进行了回顾，并对超过 40 项降压随机对照试验进行了更新的荟萃分析，其中包括超过 188000 名受试者和约 6800 起中风事件。队列研究现在表明，在亚太地区以及北美和西欧，收缩压每降低 10 毫米汞柱，60 至 79 岁受试者的风险就会降低约三分之一。这种关联持续下降到至少 115/75 mm Hg 的水平，并且在性别、地区、中风亚型以及致命和非致命事件中保持一致。比例相关性与年龄相关，但对于 80 岁的人来说仍然是强烈且正向的相关性。来自随机对照试验的数据（其中事件发生的平均年龄约为 70 岁）表明，收缩压降低 10 毫米汞柱与中风风险降低约三分之一相关。每降低一毫米汞柱收缩压，根据基线血压水平以及个人是否有心血管疾病史，不同药物对中风的益处似乎相似。然而，有证据表明，血压降低幅度越大，益处越大。结论——流行病学上降低血压对降低中风风险的预期益处在一系列不同的人群亚组中大致一致。较大的血压降低会带来更大的好处，并且开始和维持血压降低以预防中风是比初始药物的选择更重要的问题。
Background-The last few years have seen a considerable increase in the amount of information available concerning blood pressure (BP) and stroke associations. This article provides an overview of published reviews of the effects on stroke seen in trials of BP-lowering drugs and compares these with the results available from cohort studies.Summary of Review-We present a review of major overviews of prospective cohort studies and an updated meta-analysis of >40 randomized controlled trials of BP lowering, which included >188000 participants and approximately 6800 stroke events. Cohort studies now indicate that in the Asia Pacific region as well as in North America and Western Europe, each 10 mm Hg lower systolic BP is associated with a decrease in risk of approximately one third in subjects aged 60 to 79 years. The association is continuous down to levels of at least 115/75 mm Hg and is consistent across sexes, regions, and stroke subtypes and for fatal and nonfatal events. The proportional association is age dependent but is still a strong and positive association in those aged 80 years. Data from randomized controlled trials, in which mean age at event was approximately 70 years, indicate that a 10 mm Hg reduction in systolic BP is associated with a reduction in risk of stroke of approximately one third. Per mm Hg systolic BP reduction, the benefits for stroke appear similar between agents, by baseline BP levels, and whether or not individuals have a past history of cardiovascular disease. There is, however, evidence of greater benefit with a larger BP reduction.Conclusions-The epidemiologically expected benefits of BP lowering for stroke risk reduction are broadly consistent across a range of different population subgroups. There are greater benefits from larger BP reductions, and initiating and maintaining BP reduction for stroke prevention is a more important issue than choice of initial agent.