Initial Combination Therapy Reduces the Risk of Cardiovascular Events in Hypertensive Patients A Matched Cohort Study
Initial Combination Therapy Reduces the Risk of Cardiovascular Events in Hypertensive Patients A Matched Cohort Study
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DOI：
10.1161/hypertensionaha.112.201566
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发表时间：
2013-02-01
期刊：
影响因子：
8.3
通讯作者：
Duh, Mei Sheng
中科院分区：
文献类型：
--
作者：
Gradman, Alan H.;Parise, Helene;Duh, Mei Sheng
本研究评估了初始与延迟联合用药对高血压患者血压（BP）控制和心血管事件风险的影响。临床试验表明，控制血压的时间是长期预后的重要决定因素，但实际证据很少。使用电子病历（2005-2009），我们回顾性分析了1762例开始联合治疗的血压升高的成年患者，这些患者与开始单一治疗的相似患者的比例为1:1，后来转到联合治疗。比较各组间心血管事件（心肌梗死、卒中/短暂性脑缺血发作或心力衰竭住院）或全因死亡的发生率比，以及到血压控制时间的Kaplan-Meier分析。使用时变Cox比例风险模型估计初始治疗对CV事件和BP控制的影响的风险比。初始联合治疗与CV事件或死亡风险的显著降低相关（发病率比为0.66[95%可信区间，0.52-0.84]；P=0.0008）。治疗6个月后，接受初始联合治疗和延迟联合治疗的患者分别有40.3%和32.6%达到血压控制。达到目标血压与心血管事件或死亡风险降低23%相关（风险比0.77[95%可信区间，0.61-0.96]；P=0.0223）；初始联合治疗的残留效应未达到统计学意义（风险比0.84[95%可信区间0.68-1.03]；P=0.0935）。初始联合治疗与心血管事件风险的显著降低相关。更快地达到目标BP被发现是估计风险降低的主要因素。(高血压。2013;61:309 - 318)。
This study evaluated the effects of initial versus delayed treatment with a drug combination on blood pressure (BP) control and the risk of cardiovascular (CV) events in hypertensive patients. Clinical trials suggest that the time to BP control is an important determinant of long-term outcomes, but real-world evidence is scarce. Using electronic medical charts (2005-2009), we retrospectively analyzed 1762 adult patients with BP elevation initiating combination therapy matched 1:1 with similar patients initiating monotherapy and later switched to combination therapy. Incidence rate ratios of CV events (myocardial infarction, stroke/transient ischemic attack, or hospitalization for heart failure) or all-cause death and Kaplan-Meier analyses of time to BP control were compared between cohorts. Hazard ratios indicating the effects of initial treatment on CV events and BP control were estimated using time-varying Cox proportional hazard models. Initial combination therapy was associated with a significant reduction in the risk of CV events or death (incidence rate ratio, 0.66 [95% confidence interval, 0.52-0.84]; P=0.0008). After 6 months of therapy, 40.3% and 32.6% of patients with initial versus delayed combination treatment reached BP control, respectively. Achieving target BP was associated with a statistically significant risk reduction of 23% for CV events or death (hazard ratio, 0.77 [95% confidence interval, 0.61-0.96]; P=0.0223); the residual effect of initial combination therapy did not reach statistical significance (hazard ratio, 0.84 [95% confidence interval, 0.68-1.03]; P=0.0935). Initial combination therapy was associated with a significant risk reduction of cardiovascular events. More rapid achievement of target BP was found to be the main contributor to the estimated risk reduction. (Hypertension. 2013;61:309-318.)