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Lancet:强化降压治疗带来的好处让你意想不到

2015-11-06 崔倩 译 MedSci原创

最近高血压指南已经逆转了以前对高危患者降低血压的目标,如心血管疾病,肾脏疾病,或糖尿病。这种变化表示关于是否强化降血压策略与主要心血管和肾脏事件的风险降低相关有更多的不确定性。该研究的目的是评估强化降血压策略的有效性和安全性。对于此更新的系统回顾和荟萃分析,研究人员系统检索了MEDLINE,Embase,和Cochrane图书馆于1950年1月1日和2015年11月3日间发表的试验。研究人员将那些

最近的高血压指南已经逆转了以前对高危患者(如心血管疾病、肾脏疾病、糖尿病)降压的目标。这种变化表示关于是否强化降血压策略与主要心血管事件和肾脏事件的风险降低相关有更多的不确定性。该研究的目的是评估强化降血压策略的有效性和安全性。

对于此更新的系统回顾和荟萃分析,研究人员系统检索了MEDLINE,Embase,和Cochrane图书馆于1950年1月1日和2015年11月3日间发表的试验。研究人员将那些至少有6个月的随访的随机对照试验纳入此研究,这些研究随机分配参与者更多强化与更少强化降压治疗,具有不同的目标血压或基线开始的血压的变化。研究人员没有使用任何年龄或语言限制。研究人员做了一项荟萃分析,关于降低血压对主要心血管事件(心肌梗死、中风、心脏衰竭、或心血管死亡,单独和组合)的相对危险度(RR),以及对非血管和全因死亡率、终末期肾病、和不良事件,以及白蛋白尿和糖尿病患者视网膜病进展的研究。

研究人员确定了19项试验,包括44989名参与者,其中2496例主要心血管事件在平均随访3.8年(范围1.0-8.4年)中被记录下来。该荟萃分析表明,随机分组后,更多的强化降压组的患者的平均血压水平为133/76mm Hg,而更少强化降压治疗组为140/81mm Hg。强化降压治疗降低了主要心血管事件(14%[95%Cl 4至22])、心肌梗死(13%[0至24])、中风(22%[10至32])、蛋白尿(10%[3至16])和视网膜病的进展(19%[0至34])的RR。然而,更多的强化治疗对心脏衰竭(15%[95%Cl -11至34])、心血管死亡(9%[-11至26])、总死亡率(9%[-3至19])或终末期肾脏疾病(10%[-6至23])没有明显的影响。主要心血管事件减少在患者群体中是一致的,并且降血压有明显的好处,即使患者收缩压超过140mmHg。

在试验中,所有参加试验的有血管疾病、肾脏疾病或糖尿病的患者获得的绝对益处都是最大的。与降血压相关的严重不良事件只在六个试验中有报告,更多强化降压组患者的事件发生率为每年1.2%,更少的强化治疗组为0.9%(RR 1.35 [95%Cl 0.93-1.97])。严重低血压在强化治疗组更加频繁(RR 2.68 1.21-5.89],p=0.015),但绝对过剩较小(随访期间每人年0.3% vs 0.1%)。

强化降压比标准方案提供了更大的血管保护。在高危患者中,更多的强化降压带来了额外的益处,包括那些低于140mmHg收缩压的患者。高危人群强化血压降低的绝对收益都是很大的。

原始出处:

Xinfang Xie, Emily Atkins, Jicheng Lv,et al.Effects of intensive blood pressure lowering on cardiovascular and renal outcomes,Lancet,2015.11.6

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    2016-04-28 howi
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  5. [GetPortalCommentsPageByObjectIdResponse(id=1828293, encodeId=1a891828293a0, content=<a href='/topic/show?id=1b6210686b2' target=_blank style='color:#2F92EE;'>#Lancet#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=64, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=10686, encryptionId=1b6210686b2, topicName=Lancet)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=3f0227, createdName=howi, createdTime=Thu Apr 28 08:34:00 CST 2016, time=2016-04-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1291853, encodeId=b71b129185361, content=<a href='/topic/show?id=9d32981418b' target=_blank style='color:#2F92EE;'>#降压#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=67, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=98141, encryptionId=9d32981418b, topicName=降压)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8f14236, createdName=经常头晕, createdTime=Sun Nov 08 12:34:00 CST 2015, time=2015-11-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1360851, encodeId=873a136085166, content=<a href='/topic/show?id=87fe98146d7' target=_blank style='color:#2F92EE;'>#降压治疗#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=81, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=98146, encryptionId=87fe98146d7, topicName=降压治疗)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=30bd35, createdName=xugumin, createdTime=Sun Nov 08 12:34:00 CST 2015, time=2015-11-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1419065, encodeId=145814190657a, content=<a href='/topic/show?id=e051501461d' target=_blank style='color:#2F92EE;'>#强化降压#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=83, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=50146, encryptionId=e051501461d, topicName=强化降压)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=2c6c3470765, createdName=fengxx, createdTime=Sun Nov 08 12:34:00 CST 2015, time=2015-11-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=42769, encodeId=538b42e69e9, content=希望有用吧,现在很多人都有这些病, beContent=null, objectType=article, channel=null, level=null, likeNumber=153, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20151021/IMG562795A9BB09E1503.jpg, createdBy=52b31658114, createdName=winter9345, createdTime=Sat Nov 07 21:54:00 CST 2015, time=2015-11-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=42726, encodeId=fe0d42e2603, content=这绝对是有意义的。以前我院老年科一主任医师就说过,正常人在120左右的血压就可以满足机体需求,为什么高血压患者就不能呢。, beContent=null, objectType=article, channel=null, level=null, likeNumber=145, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20150625/IMG558B8C995D7262168.jpg, createdBy=36ad1623080, createdName=cyzj007, createdTime=Sat Nov 07 12:10:00 CST 2015, time=2015-11-07, status=1, ipAttribution=)]
    2015-11-07 winter9345

    希望有用吧,现在很多人都有这些病

    0

  6. [GetPortalCommentsPageByObjectIdResponse(id=1828293, encodeId=1a891828293a0, content=<a href='/topic/show?id=1b6210686b2' target=_blank style='color:#2F92EE;'>#Lancet#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=64, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=10686, encryptionId=1b6210686b2, topicName=Lancet)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=3f0227, createdName=howi, createdTime=Thu Apr 28 08:34:00 CST 2016, time=2016-04-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1291853, encodeId=b71b129185361, content=<a href='/topic/show?id=9d32981418b' target=_blank style='color:#2F92EE;'>#降压#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=67, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=98141, encryptionId=9d32981418b, topicName=降压)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8f14236, createdName=经常头晕, createdTime=Sun Nov 08 12:34:00 CST 2015, time=2015-11-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1360851, encodeId=873a136085166, content=<a href='/topic/show?id=87fe98146d7' target=_blank style='color:#2F92EE;'>#降压治疗#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=81, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=98146, encryptionId=87fe98146d7, topicName=降压治疗)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=30bd35, createdName=xugumin, createdTime=Sun Nov 08 12:34:00 CST 2015, time=2015-11-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1419065, encodeId=145814190657a, content=<a href='/topic/show?id=e051501461d' target=_blank style='color:#2F92EE;'>#强化降压#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=83, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=50146, encryptionId=e051501461d, topicName=强化降压)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=2c6c3470765, createdName=fengxx, createdTime=Sun Nov 08 12:34:00 CST 2015, time=2015-11-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=42769, encodeId=538b42e69e9, content=希望有用吧,现在很多人都有这些病, beContent=null, objectType=article, channel=null, level=null, likeNumber=153, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20151021/IMG562795A9BB09E1503.jpg, createdBy=52b31658114, createdName=winter9345, createdTime=Sat Nov 07 21:54:00 CST 2015, time=2015-11-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=42726, encodeId=fe0d42e2603, content=这绝对是有意义的。以前我院老年科一主任医师就说过,正常人在120左右的血压就可以满足机体需求,为什么高血压患者就不能呢。, beContent=null, objectType=article, channel=null, level=null, likeNumber=145, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20150625/IMG558B8C995D7262168.jpg, createdBy=36ad1623080, createdName=cyzj007, createdTime=Sat Nov 07 12:10:00 CST 2015, time=2015-11-07, status=1, ipAttribution=)]
    2015-11-07 cyzj007

    这绝对是有意义的。以前我院老年科一主任医师就说过,正常人在120左右的血压就可以满足机体需求,为什么高血压患者就不能呢。

    0

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