之前患有中风的患者的最佳血压目标:系统性审查和元分析
Toshiki Maeda1, Yuichiro Ohya2, Shintaro Ishida3
1Department of Preventive Medicine and Public Health, Faculty of Medicine, Fukuoka University, Fukuoka, Japan. tmaeda@fukuoka-u.ac.jp.
概括
密集的血压控制 (静心血压<130 mmHg) 显著降低了先前中风患者的复发性中风和心血管事件. 虽然密集控制增加了头,但好处超过了这种风险,支持降低中风预防的目标.
科学领域:
- 心脏病学 心脏病学
- 神经学 神经学
- 临床试验 临床试验
背景情况:
- 优化血压管理对于预防二次中风至关重要.
- 以前的指导方针建议,对于有中风病史的患者,静脉血压 (SBP) 目标<140 mmHg.
研究的目的:
- 系统地审查和元分析随机对照试验 (RCT),比较先前中风患者的密集血压控制 (SBP <130 mmHg) 与标准血压控制 (SBP <140 mmHg).
- 评估强化血压目标的有效性和安全性,以减少复发性中风和主要心血管事件.
主要方法:
- 在PubMed/MEDLINE,Cochrane数据库和Ichu-shi. 的系统文献搜索.
- 包括七个RCT用于使用随机效应模型进行定量元分析.
- 对包含试验的偏差风险的评估.
主要成果:
- 强化血压控制显著减少了复发性中风 (RR,0.79;95% CI,0.65-0.96) 和主要心血管事件 (RR,0.86;95% CI,0.76-0.97).
- 强化控制对出血性中风 (RR,0.33;95% CI,0.15-0.74) 比缺血性中风 (RR,0.87;95% CI,0.71-1.08) 更有效.
- 随着密集控制 (RR,1.30;95% CI,1.00-1.68),昏和头等不良事件更频繁,但中风和心血管事件的绝对风险降低超过了这一增加.
结论:
- 对于先前中风的患者,建议较低的SBP目标<130 mmHg.
- 这种密集的血压控制策略有效地预防了复发性中风和主要心血管事件.
- 在实施密集的血压控制时,建议对低血压相关症状进行仔细监测.
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