Patient Selection for Intensive Blood Pressure Management Based on Benefit and Adverse Events.
Patient Selection for Intensive Blood Pressure Management Based on Benefit and Adverse Events.
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基于获益和不良事件的强化血压管理患者选择。
DOI：
10.1016/j.jacc.2021.02.058
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发表时间：
2021-04-27
影响因子：
24
通讯作者：
SPRINT Research Group
中科院分区：
文献类型：
--
作者：
Bress AP;Greene T;Derington CG;Shen J;Xu Y;Zhang Y;Ying J;Bellows BK;Cushman WC;Whelton PK;Pajewski NM;Reboussin D;Beddu S;Hess R;Herrick JS;Zhang Z;Kolm P;Yeh RW;Basu S;Weintraub WS;Moran AE;SPRINT Research Group
平均而言，强化收缩压(SBP)治疗可以预防心血管疾病(CVD)高危患者的心血管事件，尽管不同患者的益处可能有所不同。这项研究的目的是预测强化SBP治疗与标准SBP治疗的益处大小(降低心血管疾病和全因死亡风险)以及不良事件(AE)风险。这是对Sprint(收缩压干预试验)的二次分析。单独的受益结果是第一次出现：1)急性心肌梗死或其他急性冠脉综合征、中风、心力衰竭或心血管疾病死亡的心血管疾病复合体；以及2)全因死亡。与治疗相关的不良反应包括低血压、晕厥、心动过缓、电解质异常、损伤性跌倒和急性肾损伤。改良弹性净COX回归用于预测每种结局的绝对风险和绝对风险差异，其基础是在重症监护与标准治疗时可用的36个基线变量。在8,828名短跑参与者中(平均年龄67.9岁，女性占35%)，在3.26年的中位随访期内，发生了600起CVD复合事件，363例全因死亡，481例与治疗相关的AEs。对单个参与者的心血管疾病综合风险(C指数=0.71)、全因死亡率(C指数=0.75)和与治疗相关的不良事件(C指数=0.69)进行了预测。更高的基线心血管风险与更大的益处相关(即，更大的绝对心血管风险降低)。预测的心血管疾病收益和预测的与治疗相关的AE风险增加是相关的(Spearman相关系数=−0.72)，处于预测收益最高三分位数的参与者中，95%的人也具有与治疗相关的AE风险的高或中等预测增加。很少有人被预测为高收益低AE风险(1.8%)或低收益高AE风险(1.5%)。在全因死亡率方面也得到了类似的结果。基线预测心血管疾病风险较高的Sprint参与者从强化治疗中获得了更大的绝对好处。预期受益较高的参与者也最有可能经历与治疗相关的AEs，但AEs通常是轻微和短暂的。患者应该优先接受强化SBP治疗，以获得更高的预期收益。(收缩压干预试验[Sprint]；NCT01206062)
Intensive systolic blood pressure (SBP) treatment prevents cardiovascular disease (CVD) events in patients with high CVD risk on average, though benefits likely vary among patients. The aim of this study was to predict the magnitude of benefit (reduced CVD and all-cause mortality risk) along with adverse event (AE) risk from intensive versus standard SBP treatment. This was a secondary analysis of SPRINT (Systolic Blood Pressure Intervention Trial). Separate benefit outcomes were the first occurrence of: 1) a CVD composite of acute myocardial infarction or other acute coronary syndrome, stroke, heart failure, or CVD death; and 2) all-cause mortality. Treatment-related AEs of interest included hypotension, syncope, bradycardia, electrolyte abnormalities, injurious falls, and acute kidney injury. Modified elastic net Cox regression was used to predict absolute risk for each outcome and absolute risk differences on the basis of 36 baseline variables available at the point of care with intensive versus standard treatment. Among 8,828 SPRINT participants (mean age 67.9 years, 35% women), 600 CVD composite events, 363 all-cause deaths, and 481 treatment-related AEs occurred over a median follow-up period of 3.26 years. Individual participant risks were predicted for the CVD composite (C index = 0.71), all-cause mortality (C index = 0.75), and treatment-related AEs (C index = 0.69). Higher baseline CVD risk was associated with greater benefit (i.e., larger absolute CVD risk reduction). Predicted CVD benefit and predicted increased treatment-related AE risk were correlated (Spearman correlation coefficient = −0.72), and 95% of participants who fell into the highest tertile of predicted benefit also had high or moderate predicted increases in treatment-related AE risk. Few were predicted as high benefit with low AE risk (1.8%) or low benefit with high AE risk (1.5%). Similar results were obtained for all-cause mortality. SPRINT participants with higher baseline predicted CVD risk gained greater absolute benefit from intensive treatment. Participants with high predicted benefit were also most likely to experience treatment-related AEs, but AEs were generally mild and transient. Patients should be prioritized for intensive SBP treatment on the basis of higher predicted benefit. (Systolic Blood Pressure Intervention Trial [SPRINT]; NCT01206062)
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影响因子：
13.8
作者：
Scarpa, Joseph;Bruzelius, Emilie;Baum, Aaron
通讯作者：
Baum, Aaron
DOI：
10.1161/circoutcomes.117.003624
发表时间：
2017-04
期刊：
Circulation. Cardiovascular quality and outcomes
影响因子：
--
作者：
Patel KK;Arnold SV;Chan PS;Tang Y;Pokharel Y;Jones PG;Spertus JA
通讯作者：
Spertus JA
影响因子：
37.8
作者：
Muntner P;Carey RM;Gidding S;Jones DW;Taler SJ;Wright JT Jr;Whelton PK
通讯作者：
Whelton PK
影响因子：
15.8
作者：
Basu S;Sussman JB;Rigdon J;Steimle L;Denton BT;Hayward RA
通讯作者：
Hayward RA
DOI：
10.1177/1740774514537404
发表时间：
2014-10
期刊：
Clinical trials (London, England)
影响因子：
--
作者：
Ambrosius WT;Sink KM;Foy CG;Berlowitz DR;Cheung AK;Cushman WC;Fine LJ;Goff DC Jr;Johnson KC;Killeen AA;Lewis CE;Oparil S;Reboussin DM;Rocco MV;Snyder JK;Williamson JD;Wright JT Jr;Whelton PK;SPRINT Study Research Group
通讯作者：
SPRINT Study Research Group