J-shaped relationship between blood pressure and mortality in hypertensive patients: New insights from a meta-analysis of individual-patient data
J-shaped relationship between blood pressure and mortality in hypertensive patients: New insights from a meta-analysis of individual-patient data
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DOI：
10.7326/0003-4819-136-6-200203190-00007
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发表时间：
2002-03-19
影响因子：
39.2
通讯作者：
Boissel, JP
中科院分区：
文献类型：
--
作者：
Boutitie, F;Gueyffier, F;Boissel, JP
背景资料：以人群为基础的高血压纵向研究通常表明，血压和死亡率之间存在持续的正相关关系。然而，在接受治疗的高血压患者中的几项研究将这种关系描述为J形，低血压患者发生事件的风险增加。目的：评估血压与死亡率之间J形关系及其与治疗的关系的证据。设计：个体患者数据的荟萃分析。设置：来自INDANA（抗高血压干预的个体数据分析）数据库的7项随机临床试验，患者：40233例高血压患者（平均随访3.9年）。干预措施：原发性β受体阻滞剂或噻嗪类利尿剂与安慰剂或不治疗的比较测量：舒张压和收缩压以及每年随访期间的心血管、非心血管和全因死亡人数。结果：分析包括1655例死亡（56%心血管）的数据。在接受治疗的患者（最低值，分别为84和80 mm Hg）和未接受治疗的患者（最低值，分别为90和85 mm Hg）中，观察到舒张压与总死亡率和心血管死亡率之间的J形关系。对于非心血管死亡，治疗组的关系为J形（最低值，84 mm Hg），对照组为阴性。收缩压也观察到类似的结果。宽脉压患者的存在并不能解释这些findings.Conclusions：在低血压患者中观察到的事件的风险增加与抗高血压治疗无关，也不是特异性的血压相关事件。健康状况不佳导致低血压和死亡风险增加可能解释了J形曲线。
Background: Population-based longitudinal studies of hypertension have usually shown a continuous and positive relationship between blood pressure and mortality. However, several studies in hypertensive patients receiving treatment have described this relationship as J-shaped, with an increased risk for events in patients with low blood pressure.Objective: To assess the evidence for a J-shaped relationship between blood pressure and mortality and its relation to treatment.Design: Meta-analysis of individual-patient data.Setting,: seven randomized clinical trials from the INDANA (INdividual Data ANalysis of Antihypertensive intervention) database.Patients: 40 233 persons with hypertension (mean follow-up, 3.9 years). Intervention: Primarily beta-blockers or thiazide diuretics versus placebo or no treatmentMeasurements: Diastolic and systolic blood pressure and number of cardiovascular, noncardiovascular, and all-cause deaths in yearly periods of follow-up.Results: The analysis included data on 1655 deaths (56% cardiovascular). A J-shaped relationship between diastolic blood pressure and risk for death was observed for total and cardiovascular mortality in treated patients (nadir, 84 and 80 mm Hg, respectively) and untreated patients (nadir, 90 and 85 mm Hg, respectively). For noncardiovascular deaths, the relationship was J-shaped in the treated group (nadir, 84 mm Hg) and negative in the control group. Similar results were observed for systolic blood pressure. The presence of patients with wide pulse pressure did not explain these findings.Conclusions: The increased risk for events observed in patients with low blood pressure was not related to antihypertensive treatment and was not specific to blood pressure-related events. Poor health conditions leading to low blood pressure and an increased risk for death probably explain the J-shaped curve.