STEP to blood pressure management of elderly hypertension: evidence from Asia.
STEP to blood pressure management of elderly hypertension: evidence from Asia.
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DOI：
10.1038/s41440-022-00875-7
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发表时间：
2022-04
期刊：
影响因子：
--
通讯作者：
Cai J
中科院分区：
文献类型：
--
作者：
Zhang WL;Cai J
随着人口的迅速老龄化，适当的血压（BP）控制对于高血压管理和预防心血管事件至关重要。在SPRINT（收缩压干预试验）研究中，即使在75岁或以上的患者中，也观察到了强化血压控制（SBP目标，<120 mmHg）的令人印象深刻的心血管益处。最近的一项荟萃分析包括来自BPLTTC（降压治疗试验协作组）的51项随机试验，超过35万名参与者，结果表明，降低血压对老年人有效，可减少主要心血管事件。步骤老年高血压患者的血压干预策略研究--一项在中国进行的多中心、随机、对照试验，为强化血压治疗提供了重要证据（SBP目标，110 mmHg至<130 mmHg）有益于老年高血压患者（年龄60-80岁），并降低心血管事件的发生率比标准治疗（目标130 mmHg至<150 mmHg）。由于亚洲人的高血压和中风负担高于白人，因此强化BP治疗在降低亚洲高血压患者包括中风在内的心血管事件风险方面比白人更具优势。家庭血压监测有助于老年患者的高血压管理。还应该注意的是，临床决策应基于患者，如脆弱性，糖尿病，中风和其他合并症，并制定BP目标。在此，我们回顾了老年高血压患者血压控制的重要临床试验，解释STEP的主要发现，并讨论了亚洲高血压管理的前景。
With a rapidly aging population, adequate blood pressure (BP) control is critical for hypertension management and prevention of cardiovascular events. Impressive cardiovascular benefits have been observed with intensive BP control (SBP target, <120 mmHg) in the SPRINT (Systolic Blood Pressure Intervention Trial) study, even in patients 75 years of age or older. A most recent meta-analysis including 51 randomized trials with over 350,000 participants from the BPLTTC (The Blood Pressure Lowering Treatment Trialists’ Collaboration) showed that BP lowering is effective in older people for reducing major cardiovascular events. The STEP (Strategy of Blood Pressure Intervention in the Elderly Hypertensive Patients) study—a multicenter, randomized, controlled trial conducted in China, provided important evidence that intensive BP treatment (SBP target, 110 mmHg to <130 mmHg) benefits older hypertensive patients (aged 60–80 years) and reduced the incidence of cardiovascular events than standard treatment (target 130 mmHg to <150 mmHg). Because Asian people have a higher burden of hypertension and stroke than Caucasian people, intensive BP treatment has more advantages in reducing the risk of cardiovascular events including stroke in Asian hypertensive patients than in Caucasian people. Home BP monitoring is helpful to facilitate hypertension management for older patients. It should also be noted that clinical decision-making should be on a patient basis, such as fragility, diabetes, stroke, and other comorbidities, with tailored BP targets. Here we review the important clinical trials of BP control in elderly hypertension, interpretate the main findings of STEP, and also discuss the perspectives of managing hypertension in Asia.
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