蔡军+张伟丽团队发NEJM:老年高血压患者须强化降压!
  • 一项多中心随机对照试验中,8511名60-80岁中国高血压患者分入强化治疗组和标准治疗组,分别以110~<130 mm Hg和130~<150 mm Hg为降压目标;
  • 两组1年后的平均收缩压为127.5和135.3 mmHg;
  • 中位随访3.34年期间,两组分别有3.5%和4.6%患者发生复合心血管事件,强化治疗组的风险显著降低26%,其中,中风、急性冠脉综合征和急性失代偿性心衰的风险降低33%、33%和73%;
  • 安全性和肾脏结局在两组间无显著差异,但强化治疗组低血压发生率升高。
主编推荐语
mildbreeze
高血压是常见的心血管死亡风险因素,但目前不同指南给出的老年高血压患者的血压管理目标还没有一个统一的建议。New England Journal of Medicine最新发表了由阜外医院高血压中心蔡军、张伟丽与团队开展的一项大型多中心临床试验(STEP试验),结果表明,对于老年高血压患者,与标准治疗(以130到<150 mm Hg为降压目标)相比,以110到<130 mm Hg为降压目标的强化治疗在减少心血管事件方面有更好的效果。该研究为老年高血压的临床管理,提供了重要证据。
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Trial of Intensive Blood-Pressure Control in Older Patients with Hypertension

在老年高血压患者中的强化血压控制试验

10.1056/NEJMoa2111437

2021-08-30, Article

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BACKGROUND: The appropriate target for systolic blood pressure to reduce cardiovascular risk in older patients with hypertension remains unclear.
METHODS: In this multicenter, randomized, controlled trial, we assigned Chinese patients 60 to 80 years of age with hypertension to a systolic blood-pressure target of 110 to less than 130 mm Hg (intensive treatment) or a target of 130 to less than 150 mm Hg (standard treatment). The primary outcome was a composite of stroke, acute coronary syndrome (acute myocardial infarction and hospitalization for unstable angina), acute decompensated heart failure, coronary revascularization, atrial fibrillation, or death from cardiovascular causes.
RESULTS: Of the 9624 patients screened for eligibility, 8511 were enrolled in the trial; 4243 were randomly assigned to the intensive-treatment group and 4268 to the standard-treatment group. At 1 year of follow-up, the mean systolic blood pressure was 127.5 mm Hg in the intensive-treatment group and 135.3 mm Hg in the standard-treatment group. During a median follow-up period of 3.34 years, primary-outcome events occurred in 147 patients (3.5%) in the intensive-treatment group, as compared with 196 patients (4.6%) in the standard-treatment group (hazard ratio, 0.74; 95% confidence interval [CI], 0.60 to 0.92; P=0.007). The results for most of the individual components of the primary outcome also favored intensive treatment: the hazard ratio for stroke was 0.67 (95% CI, 0.47 to 0.97), acute coronary syndrome 0.67 (95% CI, 0.47 to 0.94), acute decompensated heart failure 0.27 (95% CI, 0.08 to 0.98), coronary revascularization 0.69 (95% CI, 0.40 to 1.18), atrial fibrillation 0.96 (95% CI, 0.55 to 1.68), and death from cardiovascular causes 0.72 (95% CI, 0.39 to 1.32). The results for safety and renal outcomes did not differ significantly between the two groups, except for the incidence of hypotension, which was higher in the intensive-treatment group.
CONCLUSIONS: In older patients with hypertension, intensive treatment with a systolic blood-pressure target of 110 to less than 130 mm Hg resulted in a lower incidence of cardiovascular events than standard treatment with a target of 130 to less than 150 mm Hg.

First Authors:
Weili Zhang

Correspondence Authors:
Weili Zhang,Jun Cai

All Authors:
Weili Zhang,Shuyuan Zhang,Yue Deng,Shouling Wu,Jie Ren,Gang Sun,Jinfeng Yang,Yinong Jiang,Xinjuan Xu,Tzung-Dau Wang,Youren Chen,Yufeng Li,Lianchen Yao,Dianfang Li,Lixin Wang,Xiaomei Shen,Xinhua Yin,Wei Liu,Xiaoyang Zhou,Bingpo Zhu,Zihong Guo,Hualing Liu,Xiaoping Chen,Yingqing Feng,Gang Tian,Xiuyin Gao,Kazuomi Kario,Jun Cai,the STEP Study Group

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New England Journal of Medicine期刊

Moving the Goalposts for Blood Pressure — Time to Act

2021-08-30

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