Intensive vs Standard Blood Pressure Control and Cardiovascular Disease Outcomes in Adults Aged ≥75 Years: A Randomized Clinical Trial.
Intensive vs Standard Blood Pressure Control and Cardiovascular Disease Outcomes in Adults Aged ≥75 Years: A Randomized Clinical Trial.
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DOI：
10.1001/jama.2016.7050
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发表时间：
2016-06-28
期刊：
影响因子：
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通讯作者：
SPRINT Research Group
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作者：
Williamson JD;Supiano MA;Applegate WB;Berlowitz DR;Campbell RC;Chertow GM;Fine LJ;Haley WE;Hawfield AT;Ix JH;Kitzman DW;Kostis JB;Krousel-Wood MA;Launer LJ;Oparil S;Rodriguez CJ;Roumie CL;Shorr RI;Sink KM;Wadley VG;Whelton PK;Whittle J;Woolard NF;Wright JT Jr;Pajewski NM;SPRINT Research Group
老年高血压患者收缩压（SBP）的适当治疗目标仍不确定。旨在评估强化（<120 mm Hg）SBP 目标与标准（<140 mm Hg）SBP 目标相比对 75 岁或以上患有高血压但无糖尿病的患者的影响。一项多中心、随机临床试验，对象为参加收缩压干预试验 (SPRINT) 的 75 岁或以上患者。招募于 2010 年 10 月 20 日开始，随访于 2015 年 8 月 20 日结束。参与者被随机分为 SBP 目标低于 120 mm Hg（强化治疗组，n = 1317）或 SBP 目标低于 140 mm Hg（标准治疗组，n = 1319）。主要心血管疾病结局是非致命性心肌梗死、不导致心肌梗死的急性冠状动脉综合征、非致命性中风、非致命性急性失代偿性心力衰竭和心血管原因死亡的复合结果。全因死亡率是次要结果。在 2636 名参与者（平均年龄 79.9 岁；37.9% 女性）中，2510 名参与者（95.2%）提供了完整的随访数据。中位随访时间为 3.14 年，主要综合结局（强化治疗组 102 起事件 vs 标准治疗组 148 起事件；风险比 [HR]，0.66 [95% CI，0.51-0.85]）和全因死亡率（分别为 73 例死亡 vs 107 例死亡；HR，0.67 [95% CI， 0.49–0.91]）。治疗组之间严重不良事件的总体发生率没有差异（强化治疗组为 48.4%，标准治疗组为 48.3%；HR，0.99 [95% CI，0.89-1.11]）。强化治疗组的低血压绝对发生率为 2.4%，标准治疗组为 1.4%（HR，1.71 [95% CI，0.97-3.09]），晕厥为 3.0% vs 2.4%（HR，1.23 [95% CI，0.76-2.00]），电解质异常为 4.0% vs 2.7%（HR， 1.51[95% CI，0.99–2.33]），急性肾损伤为 5.5% vs 4.0%（HR，1.41 [95% CI，0.98–2.04]），伤害性跌倒为 4.9% vs 5.5%（HR，0.91 [95% CI，0.65–1.29]）。在 75 岁或以上的能走动的成年人中，与 SBP 目标低于 140 mm Hg 相比，治疗至 SBP 目标低于 120 mm Hg 导致致命和非致命主要心血管事件以及全因死亡的发生率显着降低。
The appropriate treatment target for systolic blood pressure (SBP) in older patients with hypertension remains uncertain. To evaluate the effects of intensive (<120 mm Hg) compared with standard (<140 mm Hg) SBP targets in persons aged 75 years or older with hypertension but without diabetes. A multicenter, randomized clinical trial of patients aged 75 years or older who participated in the Systolic Blood Pressure Intervention Trial (SPRINT). Recruitment began on October 20, 2010, and follow-up ended on August 20, 2015. Participants were randomized to an SBP target of less than 120 mm Hg (intensive treatment group, n = 1317) or an SBP target of less than 140 mm Hg (standard treatment group, n = 1319). The primary cardiovascular disease outcome was a composite of nonfatal myocardial infarction, acute coronary syndrome not resulting in a myocardial infarction, nonfatal stroke, nonfatal acute decompensated heart failure, and death from cardiovascular causes. All-cause mortality was a secondary outcome. Among 2636 participants (mean age, 79.9 years; 37.9% women), 2510 (95.2%) provided complete follow-up data. At a median follow-up of 3.14 years, there was a significantly lower rate of the primary composite outcome (102 events in the intensive treatment group vs 148 events in the standard treatment group; hazard ratio [HR], 0.66 [95% CI, 0.51–0.85]) and all-cause mortality (73 deaths vs 107 deaths, respectively; HR, 0.67 [95% CI, 0.49–0.91]). The overall rate of serious adverse events was not different between treatment groups (48.4% in the intensive treatment group vs 48.3% in the standard treatment group; HR, 0.99 [95% CI, 0.89–1.11]). Absolute rates of hypotension were 2.4% in the intensive treatment group vs 1.4% in the standard treatment group (HR, 1.71 [95% CI, 0.97–3.09]), 3.0% vs 2.4%, respectively, for syncope (HR, 1.23 [95% CI, 0.76–2.00]), 4.0% vs 2.7% for electrolyte abnormalities (HR, 1.51 [95% CI, 0.99–2.33]), 5.5% vs 4.0% for acute kidney injury (HR, 1.41 [95% CI, 0.98–2.04]), and 4.9% vs 5.5% for injurious falls (HR, 0.91 [95% CI, 0.65–1.29]). Among ambulatory adults aged 75 years or older, treating to an SBP target of less than 120 mm Hg compared with an SBP target of less than 140 mm Hg resulted in significantly lower rates of fatal and nonfatal major cardiovascular events and death from any cause.