Blood pressure and outcomes in very old hypertensive coronary artery disease patients: an INVEST substudy.
Blood pressure and outcomes in very old hypertensive coronary artery disease patients: an INVEST substudy.
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DOI：
10.1016/j.amjmed.2010.02.014
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发表时间：
2010-08
影响因子：
5.9
通讯作者：
Pepine, Carl J.
中科院分区：
文献类型：
--
作者：
Denardo, Scott J.;Gong, Yan;Nichols, Wilmer W.;Messerli, Franz H.;Bavry, Anthony A.;Cooper-DeHoff, Rhonda M.;Handberg, Eileen M.;Champion, Annette;Pepine, Carl J.
我们对冠状动脉疾病和高血压的高龄患者（年龄≥ 80岁）人群的了解有限，特别是血压与不良结局之间的关系。这是一项国际维他帕米SR-群多普利研究（INVEST）的次要分析，该研究涉及22，576例年龄≥ 50岁的临床稳定型高血压冠状动脉疾病患者。患者按年龄分组，以10岁为增量（年龄≥ 80岁，n = 2180; 70-<80岁，n = 6126; 60-<70岁，n = 7602;<60岁，n = 6668）。患者随机接受维拉帕米SR或阿替洛尔治疗策略，主要结局为首次发生全因死亡、非致死性心肌梗死或非致死性卒中。基线时，年龄增加与收缩压升高、舒张压降低和脉压增宽相关（P <0.001）。治疗降低了每个年龄组的收缩压、舒张压和脉压。然而，非常老的人保持最宽的脉压和最高的比例（23.6%）的主要结局。主要结局的校正风险比显示各年龄组与治疗期间收缩压和舒张压之间呈J形关系。风险比最低点处的收缩压随年龄增加而增加，最高值为高龄（140 mm Hg）。然而，在风险比最低点的舒张压仅略低于非常老（70毫米汞柱）。结果与治疗策略无关。高龄冠心病患者高血压的最佳管理可能涉及特定的收缩压和舒张压，与其他年龄组相比，收缩压和舒张压分别较高和较低。
Our understanding of the growing population of very old patients (aged ≥80 years) with coronary artery disease and hypertension is limited, particularly the relationship between blood pressure and adverse outcomes. This was a secondary analysis of the INternational VErapamil SR-Trandolapril STudy (INVEST), which involved 22,576 clinically stable hypertensive coronary artery disease patients aged ≥50 years. The patients were grouped by age in 10-year increments (aged ≥80, n = 2180; 70–<80, n = 6126; 60–<70, n = 7602; <60, n =6668). Patients were randomized to either verapamil SR- or atenolol-based treatment strategies, and primary outcome was first occurrence of all-cause death, nonfatal myocardial infarction, or nonfatal stroke. At baseline, increasing age was associated with higher systolic blood pressure, lower diastolic blood pressure, and wider pulse pressure (P <.001). Treatment decreased systolic, diastolic, and pulse pressure for each age group. However, the very old retained the widest pulse pressure and the highest proportion (23.6%) with primary outcome. The adjusted hazard ratio for primary outcomes showed a J-shaped relationship among each age group with on-treatment systolic and diastolic pressures. The systolic pressure at the hazard ratio nadir increased with increasing age, highest for the very old (140 mm Hg). However, diastolic pressure at the hazard ratio nadir was only somewhat lower for the very old (70 mm Hg). Results were independent of treatment strategy. Optimal management of hypertension in very old coronary artery disease patients may involve targeting specific systolic and diastolic blood pressures that are higher and somewhat lower, respectively, compared with other age groups.
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影响因子：
4.8
作者：
Jackson, JD;Muhlestein, JB;Anderson, JL
通讯作者：
Anderson, JL
影响因子：
24
作者：
Bestehorn, HP;Neumann, FJ;Roskamm, H
通讯作者：
Roskamm, H
影响因子：
120.7
作者：
Pepine, CJ;Handberg, EM;Parmley, WW
通讯作者：
Parmley, WW
DOI：
10.1111/j.1532-5415.2007.01069.x
发表时间：
2007-03-01
影响因子：
6.3
作者：
Oates, Daniel J.;Berlowitz, Dan R.;Borzecki, Ann M.
通讯作者：
Borzecki, Ann M.
影响因子：
168.9
作者：
Lewington, S;Clarke, R;Collins, R
通讯作者：
Collins, R