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强化降压治疗对患者报告结局的影响
Effect of Intensive Blood-Pressure Treatment on Patient-Reported Outcomes


Dan R. Berlowitz ... 心脑血管疾病 • 2017.08.24
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摘要


背景

收缩压干预试验(Systolic Blood Pressure Intervention Trial,SPRINT)此前报道,对有高血压和心血管风险上升,但患糖尿病的患者而言,接受强化治疗(目标收缩压低于120 mmHg)的患者比接受标准治疗(目标收缩压低于140 mmHg)的患者心血管事件发生率低。目前尚不确定这种强化治疗是否会影响由患者报告的结局。我们在此报道该研究的相关结果。

 

方法

我们将9,361例高血压参与者随机分为收缩压目标低于120 mmHg组或低于140 mmHg组,患者报告结局包括退伍军人兰德12项健康调查(Veterans RAND 12-Item Health Survey,VR-12)中的躯体健康状况(Physical Component Summary,PCS)和精神健康状况(Mental Component Summary,MCS)评分、患者健康问卷9项抑郁量表(Patient Health Questionnaire 9-item depression scale,PHQ-9)、患者报告的血压管理和降压药物满意度,以及对降压药物的依从性。我们在所有患者中比较了强化治疗组和标准治疗组的评分,还根据躯体和认知功能分层进行了比较。

 

结果

接受强化治疗的患者平均多服用了1种降压药,强化治疗组的收缩压比标准治疗组低14.8 mmHg(95%置信区间[CI],14.3~15.4)。平均PCS、MCS和PHQ-9评分在中位3年随访期间相对稳定,两组间无显著差异。根据躯体和认知功能的基线测量值对参与者进行分层,未发现治疗组间的显著差异。两组参与者的血压管理满意度均较高,我们未发现对降压药物依从性的显著差异。

 

结论

接受强化治疗(目标收缩压低于120 mmHg)的患者报告结局和接受标准治疗的相似,在躯体和认知功能减退的参与者中也是如此(由美国国立卫生研究院[National Institutes of Health,NIH]资助,SPRINT在ClinicalTrials.gov注册号为NCT01206062)。





作者信息

Dan R. Berlowitz, M.D., M.P.H., Capri G. Foy, Ph.D., Lewis E. Kazis, Sc.D., Linda P. Bolin, Ph.D., R.N., Molly B. Conroy, M.D., M.P.H., Peter Fitzpatrick, M.D., Tanya R. Gure, M.D., Paul L. Kimmel, M.D., Kent Kirchner, M.D., Donald E. Morisky, Sc.D., M.S.P.H., Jill Newman, M.S., Christine Olney, Ph.D., R.N., Suzanne Oparil, M.D., Nicholas M. Pajewski, Ph.D., James Powell, M.D., Thomas Ramsey, Ph.D., M.B.A., Debra L. Simmons, M.D., Joni Snyder, M.A., Mark A. Supiano, M.D., Daniel E. Weiner, M.D., and Jeff Whittle, M.D., for the SPRINT Research Group*
From the Center for Healthcare Organization and Implementation Research, Bedford Veterans Affairs (VA) Hospital, Bedford (D.R.B., L.E.K.), and Boston University Schools of Medicine and Public Health (D.R.B., L.E.K.) and Tufts Medical Center (D.E.W.), Boston — all in Massachusetts; Wake Forest School of Medicine, Winston-Salem (C.G.F., J.N., N.M.P.), and East Carolina University College of Nursing (L.P.B.) and Brody School of Medicine (J.P.), East Carolina University, Greenville — both in North Carolina; the University of Pittsburgh, Pittsburgh (M.B.C.); Mayo Clinic Florida, Jacksonville (P.F.); the Ohio State Wexner Medical Center, Columbus (T.R.G.); the National Institute of Diabetes and Digestive and Kidney Diseases (P.L.K.) and the National Heart, Lung, and Blood Institute (J.S.), Bethesda, MD; the G.V. (Sonny) Montgomery VA Medical Center, Jackson, MS (K.K.); UCLA Fielding School of Public Health, Los Angeles (D.E.M.); Minneapolis VA Medical Center, Minneapolis (C.O.); University of Alabama at Birmingham, Birmingham (S.O., T.R.); University of Utah School of Medicine (D.L.S., M.A.S.) and VA Geriatric Research, Education and Clinical Center (M.A.S.), Salt Lake City; and the Clement J. Zablocki VA Medical Center, Milwaukee (J.W.). Address reprint requests to Dr. Berlowitz at the Bedford VA Hospital, 200 Springs Rd., Bedford, MA 01730, or at dan.berlowitz@va.gov. *A complete list of investigators in the Systolic Blood Pressure Intervention Trial (SPRINT) Research Group is provided in the Supplementary Appendix, available at NEJM.org.

 

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