Systolic Blood Pressure Time in Target Range and Cardiovascular Outcomes in Patients With Hypertension.
Systolic Blood Pressure Time in Target Range and Cardiovascular Outcomes in Patients With Hypertension.
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DOI：
10.1016/j.jacc.2021.01.014
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发表时间：
2021-03-16
影响因子：
24
通讯作者：
Buckley LF
中科院分区：
文献类型：
--
作者：
Fatani N;Dixon DL;Van Tassell BW;Fanikos J;Buckley LF
标准的血压控制指标可能不会考虑血压随时间的变化。这项研究试图评估成人高血压患者在收缩压目标范围内的时间与主要不良心血管事件之间的独立相关性。这项研究是对Sprint的事后分析，这是一项随机临床试验，比较了患有高血压和心血管风险较高的成年人的强化(<；120 mm Hg)和标准(<；140 mm Hg)收缩压治疗干预措施。密集武器和标准武器的目标范围分别定义为110-130 mm Hg和120-140 mm Hg。在随访的前3个月，使用线性插值法估计在目标范围内的时间。使用调整后的COX比例风险回归模型估计在目标范围内的时间与主要不良心血管事件之间的关联。在目标范围内时间较长的参与者更年轻，10年心血管风险较低，基线收缩压较低，更有可能是女性和他汀类药物使用者。在完全调整的模型中，目标范围内的时间每增加1个标准差，就会显著降低第一次主要不良心血管事件的风险。尽管对平均收缩压或收缩压变异性进行了调整，但在目标范围内的时间仍与主要不良心血管事件显著相关。在平均收缩压达到或低于目标的参与者中，在目标范围内的时间仍然与主要不良心血管事件有关。在收缩压目标范围内的时间独立地预测主要不良心血管事件风险。在完全调整的模型中，在对平均收缩压进行进一步调整后，在平均收缩压达到或低于目标的参与者中，目标范围内每增加1个标准差的时间，就会显著降低第一次重大心血管不良事件的风险。在收缩压目标范围内的时间独立地预测主要不良心血管事件风险。在目标范围内的时间可能是基于人群的质量评估和临床试验干预的有用的血压控制指标。
Standard blood pressure control metrics may not account for changes in blood pressure over time. This study sought to estimate the independent association between time in systolic blood pressure target range and major adverse cardiovascular events among adults with hypertension. This study was a post-hoc analysis of SPRINT, a randomized clinical trial that compared intensive (<120 mm Hg) and standard (<140 mm Hg) systolic blood pressure treatment interventions in adults with hypertension and high cardiovascular risk. Target range was defined as 110–130 mm Hg and 120–140 mm Hg for the intensive and standard arms, respectively. Time in target range was estimated over the first 3 months of follow-up using linear interpolation. The association between time in target range with major adverse cardiovascular events was estimated using adjusted Cox proportional hazards regression models. Participants with greater time in target range were younger, had lower 10-year cardiovascular risk and lower baseline systolic blood pressure and were more likely women and statin users. Each 1-standard deviation increase in time in target range associated significantly with a decreased risk of first major adverse cardiovascular event in fully adjusted models. Time in target range remained significantly associated with major adverse cardiovascular events despite adjustment for mean systolic blood pressure or systolic blood pressure variability. Among participants with mean systolic blood pressure at or below target, time in target range remained associated with major adverse cardiovascular events. Time in systolic blood pressure target range independently predicts major adverse cardiovascular event risk. Each 1-standard deviation increase in time in target range associated significantly with a decreased risk of first major adverse cardiovascular event in fully adjusted models, after further adjustment for mean systolic blood pressure and among participants with mean systolic blood pressure at or below target. Time in systolic blood pressure target range independently predicts major adverse cardiovascular event risk. Time in target range may be a useful metric of blood pressure control for population-based quality assessment and clinical trial interventions.
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影响因子：
37.8
作者：
Soliman EZ;Ambrosius WT;Cushman WC;Zhang ZM;Bates JT;Neyra JA;Carson TY;Tamariz L;Ghazi L;Cho ME;Shapiro BP;He J;Fine LJ;Lewis CE;SPRINT Research Study Group
通讯作者：
SPRINT Research Study Group
DOI：
10.1038/s41581-019-0244-2
发表时间：
2020-04
期刊：
Nature reviews. Nephrology
影响因子：
--
作者：
Mills KT;Stefanescu A;He J
通讯作者：
He J
DOI：
10.1177/1740774514537404
发表时间：
2014-10
期刊：
Clinical trials (London, England)
影响因子：
--
作者：
Ambrosius WT;Sink KM;Foy CG;Berlowitz DR;Cheung AK;Cushman WC;Fine LJ;Goff DC Jr;Johnson KC;Killeen AA;Lewis CE;Oparil S;Reboussin DM;Rocco MV;Snyder JK;Williamson JD;Wright JT Jr;Whelton PK;SPRINT Study Research Group
通讯作者：
SPRINT Study Research Group
DOI：
10.1056/nejmoa1511939
发表时间：
2015-11-26
期刊：
The New England journal of medicine
影响因子：
--
作者：
SPRINT Research Group;Wright JT Jr;Williamson JD;Whelton PK;Snyder JK;Sink KM;Rocco MV;Reboussin DM;Rahman M;Oparil S;Lewis CE;Kimmel PL;Johnson KC;Goff DC Jr;Fine LJ;Cutler JA;Cushman WC;Cheung AK;Ambrosius WT
通讯作者：
Ambrosius WT
影响因子：
4
作者：
Schmitt, L;Speckman, J;Ansell, J
通讯作者：
Ansell, J