Association of Intensive vs Standard Blood Pressure Control With Cerebral White Matter Lesions
Association of Intensive vs Standard Blood Pressure Control With Cerebral White Matter Lesions
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DOI：
10.1001/jama.2019.10551
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发表时间：
2019-08-13
影响因子：
120.7
通讯作者：
Bryan, R. Nick
中科院分区：
文献类型：
--
作者：
Nasrallah, Ilya M.;Pajewski, Nicholas M.;Bryan, R. Nick
重要性的影响，密集的血压降低对大脑health.Objective的影响，以评估密集的血压治疗与脑白色物质病变和brainvolumes.DESIGN，设置，和参与者的一个多中心随机临床试验的高血压成人50岁或以上，没有糖尿病或中风的历史在27个地点在美国的一项亚研究。随机化开始于2010年11月8日。整个试验于2015年8月20日提前停止，因为其主要结局（心血管事件的复合终点）和全因死亡率获益。在基线（n = 670）和4年随访（n = 449）时对一部分参与者进行脑磁共振成像（MRI）;最终随访日期为2016年7月1日。干预参与者被随机分配到收缩压（SBP）低于120 mm Hg的目标组（强化治疗，n = 355）或小于140 mm Hg（标准治疗，n = 315）。主要结果和测量主要结果是总白色病变体积从基线的变化。结果在670例接受基线MRI检查的患者中（平均年龄67.3 [SD，8.2]岁; 40.4%为女性），449例（67.0%）在随机分组后中位数3.97年完成了随访MRI，干预期中位数为3.40年。在强化治疗组中，基于稳健的线性混合模型，平均白色病变体积从4.57 cm增加到5.49 cm（3）（差异，0.92 cm（3）[95% CI，0.69 - 1.14]）vs从4.40增加至5.85 cm（3）（差异，1.45 cm（3）[95% CI，1.21至1.70]）（组间变化差异，-0.54 cm（3）[95% CI，-0.87至-0.20]）。平均总脑体积从1134.5 cm（3）降至1104.0 cm（3）（差异，-30.6 cm（3）[95% CI，-32.3至-28.8]）对比从1134.0 cm（3）降低至1107.1 cm（3）（差异，-26.9 cm（3）[95% CI，24.8 - 28.8]）（组间变化差异，-3.7 cm（3）[95%CI，-6.3至-1.1]）。结论和相关性在高血压成人中，目标SBP小于120 mm Hg，与低于140 mm Hg相比，尽管差异很小，但与脑白色病变体积的较小增加和总脑体积的较大减少显著相关。
IMPORTANCE The effect of intensive blood pressure lowering on brain health remains uncertain.OBJECTIVE To evaluate the association of intensive blood pressure treatment with cerebral white matter lesion and brain volumes.DESIGN, SETTING, AND PARTICIPANTS A substudy of a multicenter randomized clinical trial of hypertensive adults 50 years or older without a history of diabetes or stroke at 27 sites in the United States. Randomization began on November 8, 2010. The overall trial was stopped early because of benefit for its primary outcome (a composite of cardiovascular events) and all-cause mortality on August 20, 2015. Brain magnetic resonance imaging (MRI) was performed on a subset of participants at baseline (n = 670) and at 4 years of follow-up (n = 449); final follow-up date was July 1, 2016.INTERVENTIONS Participants were randomized to a systolic blood pressure (SBP) goal of either less than 120 mm Hg (intensive treatment, n = 355) or less than 140 mm Hg (standard treatment, n = 315).MAIN OUTCOMES AND MEASURES The primary outcome was change in total white matter lesion volume from baseline. Change in total brain volume was a secondary outcome.RESULTS Among 670 recruited patients who had baseline MRI (mean age, 67.3 [SD, 8.2] years; 40.4% women), 449 (67.0%) completed the follow-up MRI at a median of 3.97 years after randomization, after a median intervention period of 3.40 years. In the intensive treatment group, based on a robust linear mixed model, mean white matter lesion volume increased from 4.57 to 5.49 cm(3) (difference, 0.92 cm(3) [95% CI, 0.69 to 1.14]) vs an increase from 4.40 to 5.85 cm(3) (difference, 1.45 cm(3) [95% CI, 1.21 to 1.70]) in the standard treatment group (between-group difference in change, -0.54 cm(3) [95% CI, -0.87 to -0.20]). Mean total brain volume decreased from 1134.5 to 1104.0 cm(3) (difference, -30.6 cm(3) [95% CI, -32.3 to -28.8]) in the intensive treatment group vs a decrease from 1134.0 to 1107.1 cm(3) (difference, -26.9 cm(3) [95% CI, 24.8 to 28.8]) in the standard treatment group (between-group difference in change, -3.7 cm(3) [95% CI, -6.3 to -1.1]).CONCLUSIONS AND RELEVANCE Among hypertensive adults, targeting an SBP of less than 120 mm Hg, compared with less than 140 mm Hg, was significantly associated with a smaller increase in cerebral white matter lesion volume and a greater decrease in total brain volume, although the differences were small.