Effect of Antihypertensive Therapy on Incident Stroke in Cohorts With Prehypertensive Blood Pressure Levels A Meta-Analysis of Randomized Controlled Trials
Effect of Antihypertensive Therapy on Incident Stroke in Cohorts With Prehypertensive Blood Pressure Levels A Meta-Analysis of Randomized Controlled Trials
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DOI：
10.1161/strokeaha.111.636829
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发表时间：
2012-02-01
期刊：
影响因子：
8.3
通讯作者：
Fang, James C.
中科院分区：
文献类型：
--
作者：
Sipahi, Ilke;Swaminathan, Aparna;Fang, James C.
背景和目的——与血压正常的个体相比，高血压以及高血压前期血压水平（即120-139/80-89 mm Hg）患者中风的发生率更高。尽管多项研究表明，高血压患者血压降低可降低心血管事件（包括中风）的发生率，但治疗高血压前期血压水平是否具有类似效果仍不清楚。我们试图通过对具有高血压前期基线血压水平的队列中的抗高血压药物与安慰剂进行比较的随机试验进行荟萃分析，试图确定降低高血压前期范围内的血压是否会降低中风的发生率。方法——使用 MEDLINE 识别市场上可用的 95 种不同抗高血压药物进行的随机对照试验，总共返回 2852 个结果。排除标准包括：基线时平均血压>= 140/90 mm Hg、交叉研究以及缺乏接受安慰剂的对照组。 结果-总共纳入了涉及 70 664 名患者的 16 项试验。与安慰剂相比，随机分配到积极治疗组的患者中风风险显着降低 22%，试验间异质性很小（I-2，18.0%；RR，0.78 [95% CI，0.71-0.86]；P
Background and Purpose-Compared with normotensive individuals, there is a higher incidence of stroke in patients with hypertensive, as well as prehypertensive, blood pressure levels (ie, 120-139/80-89 mm Hg). Although several studies have shown that blood pressure reduction in hypertensive patients reduces the incidence of cardiovascular events, including stroke, it is still unknown whether treatment of prehypertensive blood pressure levels has a similar effect. We sought to determine whether reduction in blood pressure in the prehypertensive range reduces the incidence of stroke by performing a meta-analysis of randomized trials comparing an antihypertensive drug against placebo in cohorts with prehypertensive baseline blood pressure levels.Methods-Randomized controlled trials performed with the 95 different antihypertensive agents available in the market were identified using MEDLINE, returning a total of 2852 results. Exclusion criteria included: average blood pressure of >= 140/90 mm Hg at baseline, crossover studies, and lack of a control group receiving placebo.Results-A total of 16 trials involving 70 664 patients were included. Patients randomized to the active treatment arm had a statistically significant 22% reduction in the risk of stroke compared with placebo, with little heterogeneity among the trials (I-2, 18.0%; RR, 0.78 [95% CI, 0.71-0.86]; P