Effects of Intensive Versus Standard Ambulatory Blood Pressure Control on Cerebrovascular Outcomes in Older People (INFINITY)
Effects of Intensive Versus Standard Ambulatory Blood Pressure Control on Cerebrovascular Outcomes in Older People (INFINITY)
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DOI：
10.1161/circulationaha.119.041603
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发表时间：
2019-11-12
期刊：
影响因子：
37.8
通讯作者：
Wolfson，Leslie
中科院分区：
文献类型：
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作者：
White，William B.;Wakefield，Dorothy B.;Wolfson，Leslie
背景以脑白质磁共振成像高信号为代表的皮质下微血管疾病与老年高血压患者的功能下降有关。研究两种水平的24小时平均收缩压(BP)在3年内对活动能力、脑白质疾病进展和认知功能的影响。方法本试验是一项前瞻性、随机、盲目终点研究，研究对象为75岁的≥患者，这些患者患有收缩期高血压，且有脑白质高信号病变的磁共振成像证据。患者被随机分配到接受抗高血压治疗的24小时平均收缩压≤130 mm Hg(强化治疗)和≤145 mm Hg(标准治疗)。主要研究结果是3年后活动度(步态速度)和白质高强度体积增加的变化。结果在199名随机入选的患者中，队列的平均年龄为80.5岁，其中54%为女性；平均24小时收缩压为149mBp Hg。强化治疗组24小时平均收缩压为127.7 mm Hg，标准治疗组24小时平均收缩压为144.0 mm Hg，平均相差16.3 mm Hg。强化治疗组和标准治疗组步速变化差异无统计学意义(分别为0.40±2.0vs0.42±2.7 S，P=0.91)；强化治疗组大鼠脑白质高强度体积较治疗前变化(0.29%)小于标准治疗组(0.48%；P=0.03)。治疗组之间的认知结果也没有差异。标准治疗组主要心血管不良事件发生率高于强化治疗组(17例对4例，P=0.01)。在治疗组中，有或无损伤的跌倒和晕厥具有可比性。结论老年高血压患者动态血压下降的幅度降低并不会导致活动结果的差异，但与皮质下白质疾病的发生率减少有关。随着时间的推移，白质疾病累积的减少可能是保存功能的一个因素。临床试验注册URL：https://www.clinicaltrials.gov.唯一标识：NCT01650402。
BackgroundSubcortical microvascular disease represented by brain white matter hyperintensity on magnetic resonance imaging is associated with functional decline in older people with hypertension. The effects of 2 levels of 24-hour average systolic blood pressure (BP) on mobility, white matter disease progression, and cognitive function over 3 years were studied.MethodsThis trial was a prospective, randomized, blinded end-points study in patients ≥75 years of age with systolic hypertension and magnetic resonance imaging evidence of white matter hyperintensity lesions. Patients were randomized to a 24-hour mean systolic BP of ≤130 mm Hg (intensive treatment) versus ≤145 mm Hg (standard treatment) with antihypertensive therapies. Primary study outcomes were changes in mobility (gait speed) and accrual of white matter hyperintensity volume after 3 years. Changes in cognitive function (executive processing) and adverse events were also evaluated.ResultsIn 199 randomized patients, the mean age of the cohort was 80.5 years, and 54% were women; the average 24-hour systolic BP was 149 mm Hg. Goal BPs were achieved after a median treatment period of 3 to 4 months; at that time, the mean 24-hour systolic BP was 127.7 mm Hg in the intensive treatment group and 144.0 mm Hg in the standard treatment group for an average difference of 16.3 mm Hg. Changes in gait speed were not different between treatment groups (0.40±2.0 versus 0.42±2.7 s in the intensive treatment and standard treatment groups, respectively;P=0.91), whereas changes from baseline in white matter hyperintensity volumes were smaller (0.29%) in the intensive treatment group compared with the standard treatment group (0.48%;P=0.03). Cognitive outcomes also were not different between the treatment groups. Major adverse cardiovascular events were higher in the standard treatment group compared with the intensive treatment group (17 versus 4 patients;P=0.01). Falls, with or without injury, and syncope were comparable in the treatment groups.ConclusionsIntensive lowering of ambulatory BP reduction in older patients with hypertension did not result in differences in mobility outcomes but was associated with a reduction in accrual of subcortical white matter disease. Over periods >3 years, a reduction in the accumulation of white matter disease may be a factor in conserving function.Clinical Trial RegistrationURL: https://www.clinicaltrials.gov. Unique identifier: NCT01650402.