Reply to: Systolic Blood Pressure and Mortality: Role of Reverse Causation.
Reply to: Systolic Blood Pressure and Mortality: Role of Reverse Causation.
复制标题
回复：收缩压和死亡率：反向因果关系的作用。
DOI：
10.1111/jgs.15180
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发表时间：
2018
影响因子：
6.3
通讯作者：
Odden,MichelleC
中科院分区：
文献类型：
--
作者：
Wu,Chenkai;Peralta,CarmenA;Odden,MichelleC
老年人高血压的适当治疗是一个多项选择题，有不止一个正确答案。在这一人群中不太可能有一个通用的血压目标，因此科学问题应该集中在如何为每个患者建立理想的目标上。我们感谢Supiano等人的评论，1然而，我们不同意我们的观察性研究结果与随机试验结果相冲突的说法。相反，我们认为，整合不同类型研究的证据可以帮助我们实现共同的目标，即治疗那些从降压中获益最多的患者。我们同意的一点是，残余混杂是“所有观察性研究固有的基本局限性”，但我们也认为，随机对照试验从根本上受到缺乏普遍性的限制，特别是对于那些包括老年人在内的人。收缩压干预试验（SPRINT）和老年高血压试验（HYVET）是高质量的随机对照试验，研究人员努力确保他们的研究参与者尽可能具有代表性。SPRINT中纳入≥ 75岁的成人和HYVET中纳入≥ 80岁的成人代表了证明这些人群血压控制有效性的重要进展。然而，尽管作出了这些努力，仍然存在局限性。尽管SPRINT包括老年人，但SPRINT的入选/排除标准仅分别适用于19.5%和34.6%的60-74岁和75岁以上的美国成年人。2我们以前已经证明HYVET参与者的心血管并发症水平低于
The appropriate treatment of hypertension in older adults is a multiple-choice question with more than one correct answer. It is unlikely that there is a universal blood pressure goal in this population, and therefore the scientific query should center on how to establish the ideal target for each patient. We appreciate the comments by Supiano et al., 1 yet we disagree with the statement that the findings from our observational study conflict with results from randomized trials. In contrast, we believe that integrating evidence from different types of studies can help us reach our common goal of treating those patients who stand to benefit the most from blood pressure lowering.One point on which we agree is that residual confounding is a “fundamental limitation inherent in all observational studies,” but we also assert that randomized controlled trials are fundamentally limited by a lack of generalizability, especially for those including older adults. The Systolic Blood Pressure Intervention Trial (SPRINT) and the Hypertension in the Very Elderly Trial (HYVET) were high quality randomized controlled trials and the investigators made strong efforts to ensure their study participants were as representative as possible. The inclusion of adults≥ 75 years in SPRINT and≥ 80 years in HYVET represent an important advance in demonstrating the effectiveness of blood pressure control in these populations. However, despite these efforts, limitations remain. Although SPRINT was inclusive of older adults, the inclusion/exclusion criteria of SPRINT apply to only 19.5% and 34.6% of US adults aged 60–74 and 75+ years, respectively. 2 We have previously demonstrated that HYVET participants had lower levels of cardiovascular comorbidity than