Intensive blood pressure control in patients with a history of heart failure: the Systolic Blood Pressure Intervention Trial (SPRINT).
Intensive blood pressure control in patients with a history of heart failure: the Systolic Blood Pressure Intervention Trial (SPRINT).
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DOI：
10.1093/ehjcvp/pvab085
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发表时间：
2022-05-05
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收缩压干预试验（SPRINT）发现，与标准血压（BP）相比，强化血压控制可降低高危患者的心血管发病率和死亡率。在有和没有流行心血管疾病的患者中，效果是一致的。心力衰竭患者可能受益于强化血压控制，通过减缓与高血压相关的不良心脏重构。相反，一些研究表明血压较高的心力衰竭患者预后更好。2因此，心力衰竭史是否会改变强化血压控制的风险和益处尚不清楚。SPRINT将9361名年龄≥50岁、心血管风险高、收缩压为130-180 mmHg的患者随机分为强化或标准血压控制组。相关的排除标准包括糖尿病、既往卒中、过去6个月内已知有症状的心力衰竭或左心室射血分数< 35%。主要终点为急性冠状动脉综合征、中风、急性失代偿性心力衰竭或心血管原因死亡。主要安全终点是复合严重不良事件。我们使用多变量Cox比例风险回归来确定基线心力衰竭患者的有效性和安全性事件的风险。然后，我们计算了有和无基线心力衰竭患者强化与标准血压控制的有效性和安全性，并使用似然比检验检查亚组异质性。从布里格姆妇女医院机构审查委员会获得了对SPRINT数据集二次使用的豁免。在9361名参与者中，326名（3.5%）报告有心力衰竭史。在随机分配到强化和标准血压控制组的患者中，患病率无显著差异[166（3.6%）对160 (3.4%)；P = 0.73)。中位随访时间为3.26年（范围0-4.77年）。心衰病史独立与
The Systolic Blood Pressure Intervention Trial (SPRINT) found that intensive versus standard blood pressure (BP) control reduced cardiovascular morbidity and mortality in high-risk patients. 1 Effects were consistent among patients with and without prevalent cardiovascular disease. Patients with heart failure may benefit from intensive BP control by slowing the adverse cardiac remodelling associated with high BP. Conversely, some studies have suggested better outcomes among patients with heart failure who have higher BP. 2 Therefore, it remains unknown whether a history of heart failure modifies the risks and benefits of intensive BP control.SPRINT randomized 9361 individuals who were≥ 50 years of age, at high cardiovascular risk, and had a systolic BP of 130–180 mmHg to intensive or standard BP control. 1 Pertinent exclusion criteria included diabetes, prior stroke, and known symptomatic heart failure within the past 6 months or a left ventricular ejection fraction< 35%. The primary endpoint was the composite of acute coronary syndromes, stroke, acute decompensated heart failure, or death from cardiovascular causes. The principal safety endpoint was composite serious adverse events. We used multivariable Cox proportional hazards regression to determine the risk of efficacy and safety events in patients with baseline heart failure. We then calculated the efficacy and safety of intensive versus standard BP control in patients with and without baseline heart failure and examined subgroup heterogeneity using the likelihood-ratio test. A waiver for secondary use of the SPRINT data set was obtained from the Brigham and Women’s Hospital Institutional Review Board. Of the 9361 participants, 326 (3.5%) reported a history of heart failure. The prevalence did not significantly differ between patients randomized to intensive versus standard BP control [166 (3.6%) vs. 160 (3.4%); P= 0.73]. Median follow-up duration was 3.26 years (range 0–4.77 years). A history of heart failure was independently associated with
影响因子：
37.8
作者：
Yancy, Clyde W.;Jessup, Mariell;Westlake, Cheryl
通讯作者：
Westlake, Cheryl
影响因子：
5.7
作者：
Raphael, C. E.;Whinnett, Z. I.;Francis, D. P.
通讯作者：
Francis, D. P.
DOI：
10.1056/nejmoa1511939
发表时间：
2015-11-26
期刊：
The New England journal of medicine
影响因子：
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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