Effect of Intensive Blood Pressure Treatment on Heart Failure Events in the Systolic Blood Pressure Reduction Intervention Trial.
Effect of Intensive Blood Pressure Treatment on Heart Failure Events in the Systolic Blood Pressure Reduction Intervention Trial.
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DOI：
10.1161/circheartfailure.116.003613
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发表时间：
2017-04
期刊：
影响因子：
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通讯作者：
SPRINT Research Group
中科院分区：
文献类型：
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作者：
Upadhya B;Rocco M;Lewis CE;Oparil S;Lovato LC;Cushman WC;Bates JT;Bello NA;Aurigemma G;Fine LJ;Johnson KC;Rodriguez CJ;Raj DS;Rastogi A;Tamariz L;Wiggers A;Kitzman DW;SPRINT Research Group
急性失代偿性心力衰竭(ADHF)是收缩压(BP)干预试验(Sprint)中常见的常见结局。我们检验了Sprint中6个关键的预先指定的亚组：年龄≥75岁，既往心血管疾病(心血管疾病)，慢性肾脏疾病(CKD)，女性，黑人种族，以及3个基线收缩压水平(≤132vs.132vs.145vs.≥145 mm汞)之间，强化血压治疗是否有不同程度的减少ADHF事件。ADHF被定义为ADHF的住院，并由盲目事件委员会使用标准化方案进行确认和正式裁决。在3.29年的随访中，在4683名标准ARM参与者和4678名强化ARM参与者中发生ADHF事件103起(2.2%)和65起(1.4%)(COX比例风险比：0.63[95%CI：0.46-0.85]，p值=0.003)。在包括ARM治疗在内的多变量分析中，对ADHF有显著预测作用的基线协变量包括慢性肾脏病、心血管疾病、75岁的年龄≥、体重指数和较高的收缩压。干预对ADHF事件的有益效果在所有预先指定的亚组中都是一致的。发生ADHF的参与者发生心血管事件的风险显著增加，包括心血管死亡增加27倍(P<；0.001)。与140毫米汞相比，以收缩压120毫米汞柱为目标，显著减少了ADHF事件，并且在所有关键的预先指定的亚组中受益相似。发生ADHF的参与者明显增加了随后发生心血管事件和死亡的风险，这突显了旨在预防ADHF的策略的重要性，特别是强化降压。ClinicalTrials.gov编号：NCT01206062。
Acute decompensated heart failure (ADHF) was a frequent common outcome in the Systolic Blood Pressure (BP) Intervention Trial (SPRINT). We examined whether there was differential reduction in ADHF events from intensive BP treatment among the 6 key, pre-specified subgroups in SPRINT: age ≥75 years, prior cardiovascular (CV) disease (CVD), chronic kidney disease (CKD), women, black race, and 3 levels of baseline systolic BP (≤ 132 vs. >132 to <145 vs. ≥ 145 mm of Hg). ADHF was defined as hospitalization for ADHF, confirmed and formally adjudicated by a blinded events committee using standardized protocols. At 3.29 years follow-up, there were 103 ADHF events (2.2%) among 4683 standard arm participants and 65 ADHF events (1.4%) among 4678 intensive arm participants (Cox proportional Hazards Ratio: 0.63 [95% CI: 0.46–0.85], p value=0.003). In multivariable analyses including treatment arm, baseline covariates that were significant predictors for ADHF included CKD, CVD, age≥ 75 years, BMI, and higher systolic BP. The beneficial effect of the intervention on incident ADHF was consistent across all pre-specified subgroups. Participants who had incident ADHF had markedly increased risk of subsequent CV events, including a 27-fold increase (p<0.001) in CV death. Targeting a systolic BP <120 mm Hg, compared with <140 mm Hg, significantly reduced ADHF events and the benefit was similar across all key, pre-specified subgroups. Participants who developed ADHF had markedly increased risk for subsequent CV events and death, highlighting the importance of strategies aimed at prevention of ADHF, especially intensive BP reduction. ClinicalTrials.gov number: NCT01206062.