Effect of Intensive Blood Pressure Control on Aortic Stiffness in the SPRINT-HEART.
Effect of Intensive Blood Pressure Control on Aortic Stiffness in the SPRINT-HEART.
复制标题
DOI：
10.1161/hypertensionaha.120.16676
复制
发表时间：
2021-05-05
期刊：
影响因子：
--
通讯作者：
SPRINT Research Group
中科院分区：
文献类型：
--
作者：
Upadhya B;Pajewski NM;Rocco MV;Hundley WG;Aurigemma G;Hamilton CA;Bates JT;He J;Chen J;Chonchol M;Glasser SP;Hung AM;Pisoni R;Punzi H;Supiano MA;Toto R;Taylor A;Kitzman DW;SPRINT Research Group
在收缩压干预试验(SPRINT)的337名参与者(平均年龄±9岁，其中45%为女性)中，参与者被随机分配到强化治疗(目标收缩压120 mm Hg)和标准治疗(140 Mm Hg)，我们观察了强化降压对主动脉僵硬指数的影响。颈动脉-股动脉脉搏波速度(CfPWV)是一种被证实的衡量主动脉僵硬的全球性指标，在基线和18个月的随访中用回声引导的多普勒测量。心脏磁共振成像测量主动脉弹性、扩张性和顺应性。在随访期间，强化治疗组间SBP平均降低12.7毫米汞(95%可信区间：11.1-14.3毫米汞柱)。在随访期间，强化治疗显著减轻了与标准治疗相比的cfPWV增加[调整后的随访最小二乘均值=9.0m/秒(95%CI：8.79.3)对10.0m/秒(9.610.3)；p<；0.001]，即使在调整了平均动脉压之后，这种影响仍然存在。强化治疗使主动脉弹性指数[Lsm=1.38 mm Hg/mL/m2(95%CI：1.34~1.41)vs 1.48 mm Hg/mL/m2(95%CI：1.44~1.51)，p=0.002]。两组间的主动脉扩张性和顺应性没有显著差异。我们的结论是，强化治疗显著减轻了cfPWV和主动脉弹性指数的增加。在Sprint中观察到的强化BP治疗的益处的机制之一可能是减弱主动脉僵硬的增加。
In a subgroup of 337 participants (mean age 64±9 years; 45% women) from the Systolic Blood Pressure Intervention Trial (SPRINT), where participants were randomly assigned to intensive treatment (target systolic blood pressure (SBP)<120 mmHg) versus standard treatment (<140 mmHg), we examined the effect of intensive BP lowering on indexes of aortic stiffness. Carotid-femoral pulse-wave velocity (cfPWV), a validated global measure of aortic stiffness, was measured by echo-guided Doppler at baseline and 18-month follow-up visit. Aortic elastance, distensibility, and compliance were measured by cardiac magnetic resonance imaging. During follow-up, the intensive treatment produced a mean between-group reduction in SBP of 12.7 mmHg (95% confidence interval (CI):11.1–14.3 mm Hg). During follow-up, intensive treatment significantly attenuated the increase in cfPWV compared to standard treatment [adjusted follow-up least square mean (LSM) =9.0 m/sec (95% CI: 8.7–9.3) versus 10.0 m/sec (9.6–10.3); p<0.001], an effect that persisted even after adjusting for mean arterial pressure. Intensive treatment also decreased the aortic elastance index [LSM=1.38 mm Hg/mL/m2 (95% CI: 1.34–1.41) vs 1.48 mm Hg/mL/m2 (95% CI: 1.44–1.51), p=0.002] compared to standard treatment. No significant between-group differences were observed for aortic distensibility and compliance. We conclude that intensive treatment significantly attenuated increases in cfPWV and aortic elastance index. Attenuation of increases in aortic stiffness may be one of the mechanisms contributing to the benefit of intensive BP treatment observed in SPRINT.