北京协和医学院国家心血管疾病中心阜外医院蔡军、张伟丽教授课题组研究了老年高血压患者强化血压控制的疗效。相关论文于2021年8月30日发表于《新英格兰医学杂志》上。

收缩压降低老年高血压患者心血管风险的适当目标尚不清楚。

在这项多中心、随机、对照试验中，研究组在中国招募60-80岁的高血压患者，将治疗目标分为收缩压目标110-130 mm Hg（强化治疗）或收缩压目标130-150 mm Hg（标准治疗）。主要结局为中风、急性冠状动脉综合征（急性心肌梗死和不稳定心绞痛住院）、急性失代偿性心力衰竭、冠状动脉血运重建、房颤或心血管原因死亡的综合结局。

在9624名筛选合格的患者中，共有8511人被纳入试验，其中4243例被随机分配到强化治疗组，4268例被随机分配到标准治疗组。随访1年后，强化治疗组的平均收缩压为127.5 mm Hg，标准治疗组为135.3 mm Hg。中位随访3.34年后，强化治疗组中有147例患者（3.5%）发生主要结局事件，而标准治疗组中有196例（4.6%），风险比为0.74，差异显著。

主要结局的大多数单个指标也有利于强化治疗组，其中中风的风险比为0.67，急性冠脉综合征为0.67，急性失代偿性心力衰竭为0.27，冠状动脉血运重建为0.69，心房纤颤为0.96，心血管原因死亡为0.72。两组的安全性和肾功能结局无显著差异，但强化治疗组低血压发生率较高。

研究结果表明，对于老年高血压患者，收缩压目标为110-130 mm Hg的强化治疗与收缩压目标为130-150 mm Hg的标准治疗相比，可显著降低心血管事件发生率。

附：英文原文

Title: Trial of Intensive Blood-Pressure Control in Older Patients with Hypertension | NEJM

Author: Weili Zhang, M.D., Ph.D.,, Shuyuan Zhang, Ph.D.,, Yue Deng, Ph.D.,, Shouling Wu, M.D.,, Jie Ren, M.D.,, Gang Sun, M.D.,, Jinfeng Yang, M.D.,, Yinong Jiang, M.D.,, Xinjuan Xu, M.D.,, Tzung-Dau Wang, M.D., Ph.D.,, Youren Chen, M.D.,, Yufeng Li, M.D.,, Lianchen Yao, M.D.,, Dianfang Li, M.D.,, Lixin Wang, M.D.,, Xiaomei Shen, M.D.,, Xinhua Yin, M.D.,, Wei Liu, M.D.,, Xiaoyang Zhou, M.D.,, Bingpo Zhu, M.D.,, Zihong Guo, M.D.,, Hualing Liu, M.D.,, Xiaoping Chen, M.D.,, Yingqing Feng, M.D.,, Gang Tian, M.D.,, Xiuyin Gao, B.Sc.,, Kazuomi Kario, M.D., Ph.D.,, and Jun Cai, M.D., Ph.D.

Issue&Volume: 2021-08-30

Abstract: 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.

DOI: 10.1056/NEJMoa2111437

Source: https://www.nejm.org/doi/full/10.1056/NEJMoa2111437