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Circulation:强化降低血压对高血压患者左心室肥厚的影响!

2017-05-20 MedSci MedSci原创

目前尚不清楚超出推荐值的强化血压(BP)降低是否会导致高血压患者的左心室肥大(LVH)风险降低;也尚不清楚,LVH的风险降低是否可以解释在这个人群中所报告的对心血管疾病( CVD)的益处。近期,一项发表在杂志Circulation上的研究分析了8,164名具有高血压但无糖尿病的参与者(平均年龄67.9岁,女性35.3%,31.2%黑人)的收缩期血压干预(SPRINT)试验;4,086名参与者随机分

目前尚不清楚超出推荐值的强化血压(BP)降低是否会导致高血压患者的左心室肥大(LVH)风险降低;也尚不清楚,LVH的风险降低是否可以解释在这个人群中所报告的对心血管疾病( CVD)的益处。

近期,一项发表在杂志Circulation上的研究分析了8,164名具有高血压但无糖尿病的参与者(平均年龄67.9岁,女性35.3%,31.2%黑人)的收缩期血压干预(SPRINT)试验;4,086名参与者随机分配到强化降压组(目标收缩压<120mmHg)和4078名参与者分配到标准血压降低组(目标收缩压<140mmHg)。

在中位随访时间为3.81年之间,在治疗组之间比较了基线时每半年记录的标准12导联心电图,通过康奈尔电压标准定义的LVH进展和消退。

比较了强化(vs.标准)BP降低对SPRINT原发性CVD结果(心肌梗死,急性冠状动脉综合征,中风,心力衰竭和CVD死亡的综合征)的影响,并将LVH调整为随时间变化的协变量。

此项研究结果显示:基线无LVH(n = 7,559),强化(vs.标准)BP降低的SPRINT参与者与发生LVH的风险降低46%相关(HR = 0.54,95%CI:0.43至0.68)。同样,在基线具有LVH(n = 605,7.4%)的SPRINT参与者中,分配到强化(vs.标准)血压降低的患者中,LVH降低/改善的可能性高达66%(HR = 1.66,95%CI:1.31至2.11)。

LVH随时间变化协变量的调整并没有显着减弱强化BP治疗对CVD事件的影响(HR(95%CI))。

此项研究结果表明:与标准血压降低(目标收缩压<140 mmHg)相比,高血压但无糖尿病患者的强化BP降低(目标收缩压<120 mmHg)使得无LVH的患者发生LVH的概率降低;已有LVH的患者,LVH恢复率较高。但是,此项研究发现的对LVH的这种有利影响并没有解释与SPRINT试验中强化BP降低相关的CVD事件的减少。

原始出处:
Soliman EZ, Ambrosius WT, et al. Effect of Intensive Blood Pressure Lowering on Left Ventricular Hypertrophy in Patients with Hypertension: The Systolic Blood Pressure Intervention (SPRINT) Trial. Circulation. 2017 May 16. pii: CIRCULATIONAHA.117.028441. doi: 10.1161/CIRCULATIONAHA.117.028441.

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    2017-05-21 cqykthl

    无并发症的高血压患者推荐标准降压,降低左心室肥厚得发生

    0

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    2017-05-20 收获你的美

    期待后续报道

    0

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