Blood pressure targets after high-risk myocardial infarction: is it time to update the guidelines?
Blood pressure targets after high-risk myocardial infarction: is it time to update the guidelines?
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高危心肌梗死后的血压目标：是时候更新指南了吗？
DOI：
10.1161/hypertensionaha.107.099291
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发表时间：
2008
期刊：
影响因子：
8.3
通讯作者：
C. Pepine
中科院分区：
文献类型：
--
作者：
S. Denardo;R. Anderson;C. Pepine
在本期《高血压》杂志中，Thune等人分析了Valsartan在急性心肌梗死试验中的数据，以评估既往高血压和心肌梗死后血压(BP)对不良心血管结局的影响。他们对有高血压史的急性心肌梗死患者的研究结果支持了先前关于心血管不良结局风险增加的报道。此外，他们对所有心肌梗死后患者的结果，无论先前的高血压状态，收缩压过高或过低(外推他们的3个BP类别，基本上是一个“V”形曲线)，与大多数关注心肌梗死后患者的高血压管理的报告一致(基本上是“J”或“U”形曲线)。最后，据报道，他们对MI后过高或过低的舒张压的结果也有类似的偏差，但并不显著。作者将缺乏显著偏差归因于用于分析的患者数量不足(602例；占总队列的5.7%)。
那些舒张压过高或过低的患者代表了我们看到的急性心肌梗死患者中一小部分但有意义的亚群(比Thune等人报道的要大，1因为患者选择在…中服用Valsartan
In this issue of Hypertension , Thune et al1 analyze data from the Valsartan in Acute Myocardial Infarction Trial to assess the effect of antecedent hypertension and post-myocardial infarction (MI) blood pressure (BP) on adverse cardiovascular outcomes. Their results for acute MI patients with antecedent hypertension support previous reports of increased risk for adverse cardiovascular outcomes. In addition, their results for all of the post-MI patients, regardless of antecedent hypertension status, with excessively high or low systolic BP (extrapolating their 3 BP categories, essentially a “V”-shaped plot), are consistent with a majority of reports focusing on hypertension management for post-MI patients (essentially “J”- or “U”-shaped curves). Finally, their results for post-MI excessively high or low diastolic BP reportedly deviated in a similar manner but not significantly. The lack of a significant deviation was ascribed by the authors to an inadequate number of patients for analysis (602; representing 5.7% of the total cohort).
Those patients with excessively high or low diastolic BP represent a small but significant subpopulation of the patients that we see with acute MI (larger than that reported by Thune et al,1 because patients selected for the Valsartan in …