Morbidity, mortality, and antihypertensive treatment effects by extent of atherosclerosis in older adults with isolated systolic hypertension.
Morbidity, mortality, and antihypertensive treatment effects by extent of atherosclerosis in older adults with isolated systolic hypertension.
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孤立性收缩期高血压老年人动脉粥样硬化程度的发病率、死亡率和抗高血压治疗效果。
DOI：
10.1161/01.str.26.8.1319
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发表时间：
1995
期刊：
影响因子：
8.3
通讯作者：
Kuller,LH
中科院分区：
文献类型：
--
作者：
Sutton-Tyrrell,K;Alcorn,HG;Herzog,H;Kelsey,SF;Kuller,LH
背景和目的老年收缩期高血压计划(SHEP)显示，在随机分配到积极血压治疗的参与者中，中风和冠状动脉事件的发生率显著降低。选定的参与者接受了外周动脉粥样硬化的评估，并在SHEP试验结束后对心血管事件进行了跟踪。根据临床或亚临床动脉粥样硬化的存在与否来评估降压治疗的效果。方法作为SHEP的辅助研究，匹兹堡中心的190名参与者接受了外周动脉硬化的评估，其定义为颈内动脉狭窄(通过双重扫描)或下肢动脉疾病(通过踝部血压识别)。结果无动脉粥样硬化者的4年死亡率估计为4.8%，亚临床动脉粥样硬化者为16.7%，有临床证据的患者为23%(P<；.001)。三组致命性和非致命性心血管事件发生率分别为10.9%、29.8%和58.3%(P<；.001)。在调整了年龄、性别、治疗分配、吸烟和高密度脂蛋白胆固醇后，差异仍然显著。在SHEP试验开始时服用安慰剂的患者的心血管事件发生率高于被分配到积极治疗的患者(P=.011)，其中在SHEP试验结束后3年或更长时间的差异最为显著。当这项分析按有无可检测到的动脉粥样硬化进行分层时，在有疾病证据的患者中绝对治疗效果最大。结论有收缩期高血压和有外周动脉粥样硬化证据的个体发生心血管事件的风险较高。以这一群体为目标进行降压治疗将导致预防大量心血管事件。
Background and PurposeThe Systolic Hypertension in the Elderly Program (SHEP) demonstrated a significant reduction in stroke and coronary event rates among participants randomly assigned to active blood pressure treatment. Selected participants were evaluated for peripheral atherosclerosis and followed up for cardiovascular events beyond the end of the SHEP trial. Antihypertensive treatment effects were evaluated based on the presence or absence of clinical or subclinical atherosclerosis.MethodsAs an ancillary study to SHEP, 190 participants at the Pittsburgh center were evaluated for peripheral atherosclerosis, defined as either an internal carotid stenosis (by duplex scan) or lower extremity arterial disease (identified by ankle blood pressure). Participants were subsequently followed up for cardiovascular events.ResultsEstimates of 4-year mortality rates were 4.8% for participants with no atherosclerosis, 16.7% for those with subclinical atherosclerosis, and 23% among those with clinical evidence of atherosclerosis (P<.001). Fatal plus nonfatal cardiovascular event rates were 10.9%, 29.8%, and 58.3% for the three groups, respectively (P<.001). Differences remained significant after adjustment for age, sex, treatment assignment, smoking, and high-density lipoprotein cholesterol. Individuals assigned to placebo at the beginning of SHEP had higher cardiovascular event rates than individuals assigned to active treatment (P=.011), with the most striking difference 3 or more years after the end of the SHEP trial. When this analysis was stratified by the presence or absence of detectable atherosclerosis, the absolute treatment effect was largest among those with evidence of disease.ConclusionsIndividuals with systolic hypertension and evidence of peripheral atherosclerosis are at high risk for cardiovascular events. Targeting this group for antihypertensive therapy would result in the prevention of a large number of cardiovascular events.
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