抗高血压药物时间和心血管事件和死亡:BedMed随机临床试验
Scott R Garrison1,2, Jeffrey A Bakal3,4, Michael R Kolber1,2
1Pragmatic Trials Collaborative, University of Alberta, Edmonton, Canada.
JAMA
|May 12, 2025
概括
在睡前服用血压药物对高血压患者来说是安全的,但与早晨服用相比,它不会降低心血管风险. 治疗时间应与患者的偏好保持一致,以获得最佳的治疗效果.
科学领域:
- 心脏病学
- 药理学
- 临床试验
背景情况:
- 服用抗高血压药物的最佳时间仍然不确定,主要临床试验的结果不一致.
- 有关睡前使用抗高血压药物的潜在不良影响存在担忧,包括与眼相关的视力损失和低血压/ 缺血事件.
研究的目的:
- 研究睡眠时间和早晨服用抗高血压药物对主要心血管事件和死亡率的影响.
- 评估睡前服用抗高血压药物的安全性.
主要方法:
- 一个多中心,开放的实用随机临床试验,涉及加拿大5个省份的3357名高血压成年患者.
- 参与者被随机分配在睡前 (n=1677) 或早上 (n=1680) 服用每日一次的抗高血压药物,并进行盲目的终点评估.
- 随访时间中位数为4. 6年,评估主要结果是所有原因死亡或主要心血管不良事件 (中风,急性冠状动脉综合征,心力衰竭) 首次发生的时间.
主要成果:
- 在两组中,综合初级结局发生率相似 (睡前组每100个患者年为2. 3%,早上组每100个患者年为2. 4;调整后的危险比率为0. 96;P=. 70).
- 在主要结局的各个组成部分,全因住院/紧急诊所,或安全结局,包括跌倒,骨折,新诊断的青光眼,或认知衰退中没有显著差异.
- 在这一群体中,睡眠时服用抗高血压药物被认为是安全的.
结论:
- 在初级保健患者中,睡眠时服用抗高血压药物是安全的,但与早晨服用相比,不降低心血管风险.
- 服用抗高血压药物的时间似乎不会改变药物的风险和益处.
- 治疗时间的决定应优先考虑患者的偏好,以提高患者的坚持性,并可能改善长期治疗.
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