Trial of Intensive Blood-Pressure Control in Older Patients with Hypertension.
Trial of Intensive Blood-Pressure Control in Older Patients with Hypertension.
复制标题
老年高血压患者强化血压控制试验。
DOI：
10.1056/nejmc2117463
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发表时间：
2021
期刊：
影响因子：
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通讯作者：
M. Middeke
中科院分区：
文献类型：
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作者：
H. Steffen;G. Bönner;M. Middeke
编者按：在一项涉及老年高血压患者的试验中，Zhang et al.（9月29日）30期）1发现强化治疗（收缩压目标值，110至< 130 mm Hg）导致心血管事件和中风的发生率低于标准治疗（目标值，130至< 150 mm Hg）。但是，两组间抗高血压药物的使用不平衡。例如，在42个月时，强化治疗组（280例患者）比标准治疗组（102例患者）更多地使用氢氯噻嗪。最近的一项系统性综述2显示，使用钙通道阻滞剂导致的主要心血管事件风险高于使用利尿剂（风险比，1.05），但低于使用β受体阻滞剂（风险比，0.84）或血管紧张素转化酶抑制剂（风险比，0.90）。与血管紧张素受体阻滞剂相比，使用钙通道阻滞剂也可降低心肌梗死的风险（风险比为0.82）。鉴于多条证据表明，这些药物对心血管系统的影响与血压无关，3，4使用的降压药物类型可能会使试验结果产生偏倚。我们想知道作者是否可以提供一个亚组分析与降压药物的类型作为一个变量。
To the Editor: In a trial involving elderly patients with hypertension, Zhang et al.(Sept. 30 issue) 1 found that intensive treatment (systolic blood-pressure target, 110 to< 130 mm Hg) resulted in a lower incidence of cardiovascular events and stroke than standard treatment (target, 130 to< 150 mm Hg). However, the use of antihypertensive drugs was imbalanced between the two groups. For example, at 42 months, hydrochlorothiazide was used more in the intensivetreatment group (280 patients) than in the standard-treatment group (102 patients). A recent systematic review2 showed that use of calcium-channel blockers led to a higher risk of major cardiovascular events than use of diuretics (risk ratio, 1.05) but to a lower risk than use of beta-blockers (risk ratio, 0.84) or angiotensinconverting–enzyme inhibitors (risk ratio, 0.90). Use of calcium-channel blockers also led to a lower risk of myocardial infarction than use of angiotensin-receptor blockers (risk ratio, 0.82).Given that several lines of evidence have shown that these drugs affect the cardiovascular system independent of blood pressure, 3, 4 the type of antihypertensive drug used can bias trial results. We wonder whether the authors could provide a subgroup analysis with the type of antihypertensive drug as a variable.