密集血压控制与标准血压控制对心血管和结局的好坏权衡:随机对照试验的个人参与者数据分析
Xiaofan Guo1, Guozhe Sun1, Yu Xu2
1Department of Cardiology, First Hospital of China Medical University, Shenyang, China.
Lancet (London, England)
|September 3, 2025
概括
与标准控制相比,强化血压控制显著降低了心血管事件和死亡率. 尽管不良事件略有增加,但整体的益处与危害平衡有利于密集治疗,包括对的结果.
科学领域:
- 心脏病学
- 临床试验
- 公共卫生
背景情况:
- 建议进行密集的血压控制,但其益处与危害的平衡尚不确定.
- 根据血压目标和患者特征的净临床益处的变化需要量化.
研究的目的:
- 量化密集血压控制与标准血压控制的好坏权衡.
主要方法:
- 六项随机对照试验 (RCT) 的综合分析,涉及超过8万名参与者.
- 根据预先定义的纳入标准进行系统的文献搜索和数据提取.
- 用于对心血管结果和不良事件的治疗意向分析的贝叶斯等级模型.
主要成果:
- 密集的血压控制 (静脉压<120或<130毫米) 降低了复合心血管疾病的结果 (HR 0.76; 95% CrI 0.72- 0.81).
- 与心血管疾病的绝对风险降低1. 73%,以及不良事件的绝对风险增加1. 82%.
- 整体净益率为1. 14 (95% CrI为1. 03-1. 25),事件仍然为阳性 (1. 13; 95% CrI为1. 01-1. 24).
结论:
- 与标准控制相比,密集的血压控制提供了有利的益处-危害概况.
- 净益包括心血管事件的减少和不良事件的可控增加,包括事件.
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