Does earlier attainment of blood pressure goal translate into fewer cardiovascular events?
Does earlier attainment of blood pressure goal translate into fewer cardiovascular events?
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DOI：
10.1007/s11906-008-0074-2
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发表时间：
2008-10-01
影响因子：
5.6
通讯作者：
Flack, John M.
中科院分区：
文献类型：
--
作者：
Nasser, Samar A.;Lai, Zongshan;Flack, John M.
最近，临床试验数据显示，快速达到目标血压（BP）可以降低心血管疾病（CVD）事件的风险。目前尚不清楚与CVD风险程度相关的患者特征是否会影响血压控制的速度。在Kaplan-Meier生存曲线中，将达到目标收缩压（SBP）的时间与基线特征和高血压治疗强度分层进行对比。生存分析显示，蛋白尿、糖尿病、体重指数增加、高于联合国家委员会（JNC）SBP目标的毫米汞柱、较高的Fragrance风险评分、年龄较大、估计肾小球滤过率降低和抗高血压药物治疗强度较大均预测JNC SBP目标实现较慢（P < 0.015）;在所有与目标实现缓慢相关的情况下，达到目标血压时的降压药物治疗强度也更大。包括上述患者特征的考克斯比例风险模型显示，所有特征均延缓了JNC SBP目标的实现（P < 0.03）。因此，患者特征影响血压控制的速度，从业者应避免治疗惰性。
Recently, clinical trial data showed that rapid attainment of goal blood pressure (BP) reduces the risk for cardiovascular disease (CVD) events. It is unknown whether patient characteristics linked to the magnitude of CVD risk influence the speed of BP control. Time to attain goal systolic BP (SBP) in Kaplan-Meier survival curves was contrasted for strata of baseline characteristics and intensity of hypertension treatment. Survival analyses showed that albuminuria, diabetes, increased body mass index, millimeters of mercury above Joint National Committee (JNC) SBP goal, higher Framingham risk score, older age, depressed estimated glomerular filtration rate, and greater intensity of antihypertensive drug treatment all predicted slower JNC SBP goal attainment (P < 0.015); the intensity of antihypertensive drug therapy when goal BP was attained was also greater in all conditions linked to slow goal attainment. Cox proportional hazards model that included the above patient characteristics revealed all characteristics slowed attainment of JNC SBP goals (P < 0.03). Thus, patient characteristics influence speed of BP control and practitioners should avoid therapeutic inertia.