隔离性静脉压高血压的密集血压控制:对一个集群随机试验的后期分析
Chang Wang1, Songyue Liu1, Wei Miao1
1Department of Cardiology, The First Hospital of China Medical University, Shenyang, Liaoning 110001, China.
The Lancet regional health. Western Pacific
|July 23, 2024
概括
密集的血压控制到130/80mmHg以下显著降低了心血管疾病事件在患有孤立静脉缩高血压 (ISH) 的患者. 这种方法被证明是有效和安全的,为管理ISH患者提供了新的策略.
科学领域:
- 心脏病学 心脏病学
- 高血压管理 高血压管理
- 公共卫生 公共卫生
背景情况:
- 隔离性缩性高血压 (ISH) 是常见的,并与糟糕的结果相关.
- 在ISH患者中,密集控制血压 (BP) 的好处的证据有限.
- 这项研究解决了对ISH密集BP管理的直接证据的需求.
研究的目的:
- 评估密集血压控制的有效性和安全性,针对ISH患者的血压<130/80 mmHg.
- 评估密集血压控制对心血管疾病 (CVD) 事件的影响.
主要方法:
- 对中国农村高血压控制项目 (CRHCP) 的特此后分析,涉及ISH患者 (SBP≥140 mmHg,DBP<90 mmHg).
- 随机将患者分为密集血压控制 (<130/80 mmHg) 或常规护理组.
- 主要结局:复合心血管疾病事件 (中风,心肌梗塞,心力衰竭,心血管疾病死亡). 使用混合效应的考克斯回归和GEE模型进行分析.
主要成果:
- 密集血压对照组在常规护理中达到126.5/71.2 mmHg的平均血压,而在常规护理中为148.1/78.6 mmHg.
- 在密集治疗组中,心血管疾病综合发病率显著降低 (1.52% vs 2.30%/年;HR:0.64;P < 0.001),包括中风,心力衰竭和心血管疾病死亡的减少.
- 主要结果在密集控制下减少了36%;在各个子组中,好处一致. 安全结果,包括低血压,没有显著差异,除了干预组的低血压略有增加.
结论:
- 针对<130/80 mmHg的密集血压控制有效预防孤立静脉缩高血压患者的心血管事件.
- 密集的血压控制策略对ISH患者是安全的,主要不良安全结果没有显著增加.
- 这些发现支持在ISH患者中采用密集的血压管理来降低心血管疾病风险.
相关概念视频
01:18Hypertension and Regulation of Blood Pressure
2.0K
Hypertension, the most common cardiovascular disease, is diagnosed through repeated measurements of elevated blood pressure. Its risks, including damage to the kidney, heart, and brain, are directly proportional to blood pressure levels. Starting from 115/75 mm Hg, the risk of cardiovascular disease doubles with each increment of 20/10 mm Hg. The diagnosis relies on blood pressure measurements, not on patient symptoms, as hypertension is often asymptomatic until end-organ damage is imminent or...
2.0K
01:28Special considerations while measuring blood pressure
711
When assessing blood pressure (BP), healthcare professionals must consider various factors and potential unexpected outcomes to ensure accurate readings and provide proper patient care. Adhering to these guidelines is essential to achieving the most reliable results.
Monitoring Both Arms:
Monitoring BP in both arms during the initial assessment is advisable, as the systolic value may differ by five to ten mm Hg between arms. For subsequent BP assessments, use the arm with the higher reading.
Monitoring Both Arms:
Monitoring BP in both arms during the initial assessment is advisable, as the systolic value may differ by five to ten mm Hg between arms. For subsequent BP assessments, use the arm with the higher reading.
711
01:23Assessment of blood pressure in brachial artery(two-step method)
678
Measuring blood pressure is a fundamental skill in healthcare that aids in diagnosing and monitoring hypertension and other cardiovascular conditions. An aneroid sphygmomanometer, commonly used in clinical settings, offers a manual and precise method for blood pressure measurement. The technique for using this instrument involves specific steps that must be carefully executed to ensure accuracy. The following detailed description outlines a two-step technique for assessing blood pressure using...
678
01:25Antihypertensive Drugs: Direct Renin Inhibitors
528
The renin-angiotensin-aldosterone system (RAAS) is an intricate physiological pathway involving numerous enzymes and hormones, including renin, angiotensin-converting enzyme (ACE), angiotensin I and II, and aldosterone. Imbalances within this system increase the production of angiotensin II and aldosterone. Increased angiotensin II levels promote vasoconstriction and blood pressure elevation. Concurrently, higher aldosterone levels stimulate sodium and water reabsorption in the kidneys,...
528
01:17Measurement of Blood Pressure
906
Assessing blood pressure is a standard procedure executed in virtually all medical environments. The method utilized today was established over a hundred years ago by an innovative Russian doctor, Dr. Nikolai Korotkoff. The soft ticking noise, known as Korotkoff sounds, heard while taking blood pressure readings results from turbulent blood flow within the vessels. The apparatus required for this procedure includes a sphygmomanometer, a blood pressure cuff attached to a gauge, and a...
906
01:30Antihypertensive Drugs: Angiotensin-Converting Enzyme Inhibitors
589
Angiotensin-converting enzyme (ACE), a vital component of the renin-angiotensin-aldosterone system, is abundant in lung endothelial cells. ACE converts the inactive decapeptide, angiotensin I, into the active octapeptide, angiotensin II. This potent vasoconstrictor narrows blood vessels, increasing resistance to blood flow and elevating blood pressure. Angiotensin II also stimulates aldosterone production, encouraging kidney cells to reabsorb more sodium and water from urine, thereby increasing...
589