密集血压控制对中风的影响:ESPRIT试验的预先规定的二次分析
Jingkuo Li1, Lubi Lei1, Yan Li1
1National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Journal of the American College of Cardiology
|August 27, 2025
概括
与标准治疗相比,针对静脉压 (SBP) < 120 mm Hg 的强化血压治疗显著降低了出血性中风的风险 (SBP < 140 mm Hg). 预防中风的效果在一年后变得明显.
科学领域:
- 心血管医学
- 神经学
- 临床试验
背景情况:
- 血压升高是中风的主要危险因素,对该病的总体负担有很大影响.
- 降低中风压力是预防中风的关键措施.
研究的目的:
- 评估SBP强化治疗 (<120 mm Hg) 与标准治疗 (<140 mm Hg) 对中风发生率的影响.
- 分析对中风亚型的影响,包括缺血性和出血性中风.
主要方法:
- 在ESPRIT试验中,高风险的高血压患者被随机分为密集或标准的SBP治疗组.
- 随访时间为3. 4年,用于结果分析的Cox比例危险回归模型.
- 二次结局包括中风发病率,并对中风亚型和基准分析进行了后期分析.
主要成果:
- 强化SBP治疗 (<120 mm Hg) 导致出血性中风风险降低49% (HR:0. 51; 95% CI:0. 31- 0. 85; P=0. 009).
- 强化治疗没有显著增加缺血性中风风险 (HR: 0. 93; 95% CI: 0. 78- 1. 11; P=0. 423).
- 里程碑式的分析显示,预防中风的益处在一年后出现,超过一年的危险率为0. 75 (95% CI: 0. 60- 0. 94; P=0. 011).
结论:
- 与SBP<140mmHg的目标相比,有效地减半了出血性中风的风险,而没有增加缺血性中风的风险.
- 在一年的密集干预后,对中风预防的有益影响显而易见.
- 需要进一步的研究来验证这些发现.
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