在患有或没有糖尿病或先前中风的高心血管风险患者中,降低缩血压到120 mm Hg以下:一个开放的,盲目的,随机试验
Jiamin Liu1, Yan Li1, Jinzhuo Ge1
1National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, China.
Lancet (London, England)
|June 30, 2024
概括
与140mmHg目标相比,在高风险患者中降低静脉血压到120mmHg以下显著减少了主要血管事件. 这种强化治疗是有效的,不管糖尿病或中风史,风险增加最小.
科学领域:
- 心脏病学
- 高血压管理
- 临床试验
背景情况:
- 对于缩血压 (SBP) < 120 mm Hg 和 < 140 mm Hg 的优势存在不确定性.
- 这对糖尿病患者和先前中风患者尤为重要.
研究的目的:
- 在高心血管风险患者中,强化降血压 (< 120 mm Hg) 与标准降血压 (< 140 mm Hg) 的疗效和安全性进行比较.
主要方法:
- 一个开放的,盲目的,随机的受控试验, 涉及11,255名高风险的中国患者.
- 参与者被分配为密集 (< 120 mm Hg) 或标准 (< 140 mm Hg) SBP治疗目标.
- 主要结局是主要心血管不良事件 (MACE) 的组合.
主要成果:
- 强化治疗组的平均SBP为119. 1毫米升,而标准组的SBP为134. 8毫米升.
- 在密集治疗组 (9. 7%) 与标准治疗组 (11.1%) 观察到主要综合结果显著降低 (HR 0. 88;p=0. 028).
- 根据糖尿病或中风病史,没有发现异质效应. 在密集治疗组中,昏迷的频率更高.
结论:
- 在高危高血压患者,包括糖尿病患者或中风病史患者中,准SBP < 120 mm Hg有效预防主要血管事件.
- 这种密集的策略提供了显著的好处,
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