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强化降压与标准降压比较的随机试验
A Randomized Trial of Intensive versus Standard Blood-Pressure Control


The SPRINT Research Group* 心脑血管疾病 其他 • 2015.11.26
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SPRINT对最佳降压靶目标值的启示


黄晓†,霍勇‡*

† 南昌大学第二附属医院心内科;‡ 北京大学第一医院心内科

* 通讯作者

 

最佳降压靶目标值一直以来是高血压领域关注的焦点问题,不论是在老年人群、糖尿病人群以及其他心血管疾病高危人群,争议始终存在。2015年美国心脏学会(AHA)科学年会公布的SPRINT研究1,在国内外引起了各界的广泛关注与争论。该研究为临床降压治疗策略提供了重要指导价值。

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摘要 


背景

非糖尿病人群中减少心血管病发病率和死亡率的最佳收缩压目标值尚未确定。

 

方法

我们将9,361例收缩压≥130 mmHg且心血管病危险增加的患者随机分为两组。一组收缩压目标值<120 mmHg(强化治疗);另一组收缩压目标值<140 mmHg(标准治疗)。主要复合结局是心肌梗死、其他急性冠脉综合征、卒中、心力衰竭或心血管病因所致死亡。

 

结果

治疗1年时,强化治疗组的平均收缩压是121.4 mmHg,标准治疗组是136.2 mmHg。由于强化治疗组的主要复合结局较标准治疗组有显著降低(1.65%/年对2.19%/年;强化治疗风险比0.75;95%可信区间[CI],0.64~0.89;P<0.001),在中位随访3.26年后试验提前终止。在强化治疗组全因死亡率也有显著降低(风险比,0.73;95% CI,0.60~0.90;P=0.003)。除跌伤外的严重不良反应(低血压、晕厥、电解质紊乱、急性肾损害或肾衰竭)的发生在强化治疗组高于标准治疗组。

 

结论

在非糖尿病的心血管事件高危人群中,收缩压目标值<120 mmHg组较收缩压目标值<140 mmHg组更少发生致死性和非致死性主要心血管事件和任何病因死亡,但在强化治疗组中一些不良反应的发生率明显升高(研究基金来自美国国立卫生研究院;ClinicalTrials.gov注册号为NCT01206062)。





作者信息

The SPRINT Research Group*
The members of the writing committee ( Jackson T. Wright, Jr., M.D., Ph.D., Jeff D. Williamson, M.D., M.H.S., Paul K. Whelton, M.D., Joni K. Snyder, R.N., B.S.N., M.A., Kaycee M. Sink, M.D., M.A.S., Michael V. Rocco, M.D., M.S.C.E., David M. Reboussin, Ph.D., Mahboob Rahman, M.D., Suzanne Oparil, M.D., Cora E. Lewis, M.D., M.S.P.H., Paul L. Kimmel, M.D., Karen C. Johnson, M.D., M.P.H., David C. Goff, Jr., M.D., Ph.D. Lawrence J. Fine, M.D., Dr.P.H., Jeffrey A. Cutler, M.D., M.P.H., William C. Cushman, M.D., Alfred K. Cheung, M.D., and Walter T. Ambrosius, Ph.D.) assume responsibility for the overall content and integrity of the article. The affiliations of the members of the writing group are listed in the Appendix. Address reprint requests to Dr. Wright at the Division of Nephrology and Hypertension, University Hospitals Case Medical Center, Case Western Reserve University, 1100 Euclid Ave. Cleveland, OH 44106-6053, or at jackson.wright@case.edu. * A complete list of the members of the Systolic Blood Pressure Intervention Trial (SPRINT) Research Group is provided in the Supplementary Appendix, available at NEJM.org.

 

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