Association of Intensive Blood Pressure Control and Living Arrangement on Cardiovascular Outcomes by Race: Post Hoc Analysis of SPRINT Randomized Clinical Trial.
Association of Intensive Blood Pressure Control and Living Arrangement on Cardiovascular Outcomes by Race: Post Hoc Analysis of SPRINT Randomized Clinical Trial.
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DOI：
10.1001/jamanetworkopen.2022.2037
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发表时间：
2022-03-01
影响因子：
13.8
通讯作者：
Duru, O. Kenrik
中科院分区：
文献类型：
--
作者：
Inoue, Kosuke;Watson, Karol E.;Kondo, Naoki;Horwich, Tamara;Hsu, William;Bui, Alex A. T.;Duru, O. Kenrik
这项对收缩压干预试验的事后分析检查了黑人个体和非黑人个体（例如，被确定为阿拉斯加原住民、美洲印第安人、亚洲人、夏威夷原住民、太平洋岛民、白色或其他的个体）之间的生活安排是否不同，强化血压控制与心血管事件的关联。强化血压控制与心血管疾病结局的相关性是否因黑人种族和居住安排状态（即是否独居）而异？在对9342例患者的随机临床试验的二次分析中，与标准血压控制相比，收缩压目标值<120 mm Hg与心血管事件发生率较低相关（即，治疗到收缩压目标<140 mm Hg）在与其他人生活的黑人个体中，但不在独居者中。这种关联在非黑人个体中观察到，无论生活安排如何。这些研究结果强调，生活安排状态，社会隔离的一个关键组成部分，可能是建立一个量身定制的方法，以改善黑人个人的心血管健康的关键信息。独居是社会孤立的一个重要代表，也是心血管疾病的一个危险因素。此外，黑人与其他种族或族裔群体相比，血压（BP）控制较差。然而，目前尚不清楚生活安排状态是否会改变黑人个体中强化血压控制对减少心血管事件的有益作用。检查在收缩压干预试验（SPRINT）中，黑人个体和非黑人个体（例如，确定为阿拉斯加原住民、美洲印第安人、亚洲人、夏威夷原住民、太平洋岛民、白色或其他的个体）之间的生活安排是否不同，强化血压控制与心血管事件的相关性是否不同。该次要分析纳入了来自SPRINT的数据，SPRINT是一项针对心血管疾病风险增加且无糖尿病的个体的多中心研究，于2010年11月至2013年3月期间在美国102家临床研究中心招募。种族和居住安排（即，独居或与他人同住）均为自我报告。数据于2010年11月至2013年3月期间收集，并于2021年1月至2021年10月期间进行分析。SPRINT参与者被随机分配到收缩压目标低于120 mm Hg（强化治疗组）或低于140 mm Hg（标准治疗组）。调整降压药物以实现各组的目标。采用考克斯比例风险模型，根据黑人个体和其他个体的居住安排，研究强化治疗与事件复合心血管结局（截至2015年8月20日）的相关性。可运输性公式适用于推广SPRINT的研究结果，以假设的外部人口的不同比例的黑人种族和生活安排状态。在总共9342名参与者中，平均（SD）年龄为67.9（9.4）岁; 2793名参与者[30%]为黑人，2714名[29%]为独居，3320名参与者（35.5%）为女性。中位（IQR）随访时间为3.22（2.74-3.76）岁时，在1001名独居黑人中观察到67名的主要复合心血管结局（6.7%），1792名黑人中有76人与他人同居（4.2%），1713名非黑人中有108人独居（6.3%），4836名非黑人中有311人与他人同住（6.4%）。与标准治疗组相比，强化治疗组在与他人共同生活的黑人个体中复合心血管结局的发生率显著降低（风险比[HR]，0.53 [95% CI，0.33-0.85]），但在单独生活的黑人个体中并非如此（HR，1.07 [95% CI，0.66-1.73];相互作用P = 0.04）。这种关联在非黑人的个体中观察到，无论生活安排状况如何。使用可移植性，我们发现在假设的60%或更多黑人和60%或更多独居者的人群中，强化控制和心血管结局之间的关联较小或为零。在与他人同住的黑人个体和非黑人个体中，强化血压控制与较低的心血管事件发生率相关，但在单独居住的黑人个体中则不然。ClinicalTrials.gov标识符：NCT 01206062
This post hoc analysis of the Systolic Blood Pressure Intervention Trial examines whether the association of intensive blood pressure control with cardiovascular events differs by living arrangement among Black individuals and non-Black individuals (eg, individuals who identified as Alaskan Native, American Indian, Asian, Native Hawaiian, Pacific Islander, White, or other). Does the association of intensive blood pressure control with cardiovascular disease outcomes differ by Black race and living arrangement status (ie, living alone or not)? In this secondary analysis of a randomized clinical trial of 9342 individuals, intensive blood pressure control (ie, treating to a systolic blood pressure target of <120 mm Hg) was associated with lower rates of cardiovascular events compared with standard blood pressure control (ie, treating to a systolic blood pressure target of <140 mm Hg) among Black individuals living with others, but not among those living alone. The association was observed among non-Black individuals regardless of living arrangement. These findings highlight that living arrangement status, a key component of social isolation, may be critical information when building a tailored approach to improve cardiovascular health among Black individuals. Living alone, a key proxy of social isolation, is a risk factor for cardiovascular disease. In addition, Black race is associated with less optimal blood pressure (BP) control than in other racial or ethnic groups. However, it is not clear whether living arrangement status modifies the beneficial effects of intensive BP control on reduction in cardiovascular events among Black individuals. To examine whether the association of intensive BP control with cardiovascular events differs by living arrangement among Black individuals and non-Black individuals (eg, individuals who identified as Alaskan Native, American Indian, Asian, Native Hawaiian, Pacific Islander, White, or other) in the Systolic Blood Pressure Intervention Trial (SPRINT). This secondary analysis incorporated data from SPRINT, a multicenter study of individuals with increased risk for cardiovascular disease and free of diabetes, enrolled at 102 clinical sites in the United States between November 2010 and March 2013. Race and living arrangement (ie, living alone or living with others) were self-reported. Data were collected between November 2010 and March 2013 and analyzed from January 2021 to October 2021. The SPRINT participants were randomized to a systolic BP target of either less than 120 mm Hg (intensive treatment group) or less than 140 mm Hg (standard treatment group). Antihypertensive medications were adjusted to achieve the targets in each group. Cox proportional hazards model was used to investigate the association of intensive treatment with the incident composite cardiovascular outcome (by August 20, 2015) according to living arrangement among Black individuals and other individuals. Transportability formula was applied to generalize the SPRINT findings to hypothetical external populations by varying the proportion of Black race and living arrangement status. Among the 9342 total participants, the mean (SD) age was 67.9 (9.4) years; 2793 participants [30%] were Black, 2714 [29%] lived alone, and 3320 participants (35.5%) were female. Over a median (IQR) follow-up of 3.22 (2.74-3.76) years, the primary composite cardiovascular outcome was observed in 67 of 1001 Black individuals living alone (6.7%), 76 of 1792 Black individuals living with others (4.2%), 108 of 1713 non-Black individuals living alone (6.3%), and 311 of 4836 non-Black individuals living with others (6.4%). The intensive treatment group showed a significantly lower rate of the composite cardiovascular outcome than the standard treatment group among Black individuals living with others (hazard ratio [HR], 0.53 [95% CI, 0.33-0.85]) but not among those living alone (HR, 1.07 [95% CI, 0.66-1.73]; P for interaction = .04). The association was observed among individuals who were not Black regardless of living arrangement status. Using transportability, we found a smaller or null association between intensive control and cardiovascular outcomes among hypothetical populations of 60% Black individuals or more and 60% or more of individuals living alone. Intensive BP control was associated with a lower rate of cardiovascular events among Black individuals living with others and individuals who were not Black but not among Black individuals living alone. ClinicalTrials.gov Identifier: NCT01206062
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影响因子：
2.5
作者：
Miyawaki CE
通讯作者：
Miyawaki CE
DOI：
10.1161/circoutcomes.117.003624
发表时间：
2017-04
期刊：
Circulation. Cardiovascular quality and outcomes
影响因子：
--
作者：
Patel KK;Arnold SV;Chan PS;Tang Y;Pokharel Y;Jones PG;Spertus JA
通讯作者：
Spertus JA
影响因子：
37.8
作者：
Angell SY;McConnell MV;Anderson CAM;Bibbins-Domingo K;Boyle DS;Capewell S;Ezzati M;de Ferranti S;Gaskin DJ;Goetzel RZ;Huffman MD;Jones M;Khan YM;Kim S;Kumanyika SK;McCray AT;Merritt RK;Milstein B;Mozaffarian D;Norris T;Roth GA;Sacco RL;Saucedo JF;Shay CM;Siedzik D;Saha S;Warner JJ
通讯作者：
Warner JJ
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
影响因子：
6.2
作者：
Kreatsoulas, Catherine;Anand, Sonia S.
通讯作者：
Anand, Sonia S.