使用PREVENT方程来比较SPRINT中用于初级预防的密集与标准静缩血压控制
Catherine G Derington1, Ransmond O Berchie2, Tom Greene3
1Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA; Adult & Child Center for Outcomes Research & Dissemination, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.
Journal of the American College of Cardiology
|October 22, 2025
概括
强化静脉压 (SBP) 治疗显示,在所有PREVENT风险级别中,心血管疾病 (CVD) 事件的相对风险降低一致. 然而,绝对的好处差异很大,突出了PREVENT.
科学领域:
- 心脏病学 心脏病学
- 预防医学 预防医学
- 临床试验 临床试验
背景情况:
- 通过PREVENT方程,通过包括估计的膜过率和总心血管疾病事件,改善了心血管疾病 (CVD) 风险分层.
- 与较旧的计算器不同,PREVENT不包括种族,并将心力衰竭作为心血管疾病事件.
研究的目的:
- 评估密集治疗与标准系统血压 (SBP) 治疗的相对和绝对益处和危害.
- 根据新的PREVENT风险级别对这些好处和危害进行分层.
主要方法:
- 在没有患心血管疾病的参与者身上进行了SPRINT试验的二次分析.
- 预防10年心血管疾病风险计算并分为低/边缘 (<7.5%),中等 (7.5%<20%) 和高 (≥20%).
- 对于密集 (<120 mm Hg) 与标准 (<140 mm Hg) SBP治疗的危险比率 (HRs) 和绝对风险差异,对心血管疾病事件和严重不良事件进行了估计.
主要成果:
- 强化SBP治疗对心血管疾病事件的相对风险降低在PREVENT风险层中一致 (HRs从0.70到0.85不等).
- 4年内心血管疾病事件的绝对风险差异有很大差异,从低/边界组的0.002到高风险组的0.024.
- 在PREVENT层中没有观察到严重不良事件的显著相互作用 (P的相互作用=0.44).
结论:
- 密集的SBP治疗在PREVENT风险组中提供了一致的相对心血管疾病风险降低.
- 强化SBP治疗的绝对益处在高危人群中大大增加.
- 预防方程对于识别那些将从初级预防中SBP密集控制中受益最多的个体来说是有价值的.
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