加强降压和血压变异性对高血压高危患者心血管事件的长期影响

摘要

目的 观察加强降压治疗较常规治疗能否进一步降低高血压高危患者心脑血管事件的发生率,以及长期随诊血压变异性是否为心血管事件的危险因素.方法 将763例患者随机进入强化治疗组(382例)和对照组(381例).记录第4周、3个月、6个月及此后每6个月的血压值及主要终点事件.结果 在平均 4.5年随访期间,强化治疗组平均收缩压/舒张压为(133.8±6.6)/(79.7±5.5)mm Hg,明显低于对照组[(151.7±12.7)/(87.7±8.0)mmHg,P<0.001].强化治疗组随诊收缩压和舒张压的标准差(SD)及收缩压和舒张压的变异系数(CV)均明显低于对照组.与对照组相比,强化治疗组的主要终点事件降低78%,致死和非致死性中风减少72%,总死亡率和心血管病死亡率分别降低64%和82%(P均<0.001),Cox回归分析显示年龄、最终收缩压和舒张压、收缩压和舒张压的标准差是终点事件发生的危险因素.结论 强化降压治疗使血压降至132/80 mm Hg左右时可以显著地降低高血压高危患者心脑血管病事件的发病率和死亡率;长期随诊的血压变异性是高血压高危患者心脑血管病事件的危险因素.%Objective To investigate whether the intensified antihypertensive treatment, compared with the routine therapy, would further improve outcome, and whether the visit-to-visit variability in blood pressure,was the risk of cardiovascular events. Methods 763 high risk hypertensive patients were randomly assigned to either intensified antihypertensive treatment or routine therapy. 4 weeks ,3 months ,6 months, and every 6 months thereafter clinic blood pressure and primary composite end point were record in the follow-up period. Results During a mean follow-up of 4.5 years, systolic/diastolic BPs ( ± SD) decreased to ( 133.8 ± 6.6) / ( 79.7 ± 5.5 ) mm Hg in the intensive BP control group and ( 151.7 ± 12.7 ) / (87.7 ± 8.0) mm Hg in the routine therapy group. Visit-to-visit BP variability in SBP and DBP was obviously lower in the intensive BP control group than in the routine therapy group, respectively. Intensified antihypertensive treatment, compared with routine therapy, reduced total and cardiovascular mortality by 64％ and 82％ (P ＜ 0. 001 ), respectively. Furthermore, intensified antihypertensive treatment also reduced the incidence of the primary composite end point by 78％ ,and fatal and nonfatal stroke by 72％. Cox regression analysis shows that the age, average SBP and DBP, SD SBP and SD DBP were risk factor of endpoint events. Conclusions Long-term intensified antihypertensive treatment substantially lowered cardiovascular mortality and morbidity when systolic/diastolic blood pressure approximated to 132/80 mm Hg, and the long-term visit-to-visit variability in blood pressure was associated with the high risk of cardiovascular events.