Nejm: Milestone research in Chinese scholars, it is better to strengthen the pressure for elderly hypertension patients!
Framingham cardiac research and other studies have shown that hypertension as a predictive factor for the ending of the cardiovascular ending period actually exceeds the hypertension during the diastolic period. Therefore, the American Cardiac Society/ACC/AHA risk estimation tool does not consider diastolic pressure when determining cardiovascular risk.
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However, a heavy study published in the New England Medical Journal (Nejm “last year conducted a” rectification “for Shu diastolic blood pressure. The study of more than 1 million people and 36 million blood pressure measurement data shows that “upper pressure” and “lower pressure” are independent prediction factors for myocardial infarction or stroke. The 2018 European Cardiac Society (ESC) Hypertension Guide also recommends that the best relaxation pressure target of all patients with risk levels is 70 to 80 mmHg.
Subsequently, in May this year, NEJM published again the impact of hypertension with a milestone on cardiovascular disease (Sprint’s follow-up data, confirmed that positive blood pressure management-reduced systolic blood pressure to below 120mmHg-and reduced systolic blood pressure to Compared with 140mmHg, the risk of death, stroke, and these diseases have been greatly reduced, as well as death caused by all reasons.
However, for elderly patients with hypertension, although many large trials have shown that strengthening the pressure of antihypertension is good for the ending of the cardiovascular vessels, the appropriate systolic blood pressure target is unclear, and the international guide recommendation is inconsistent. In particular, it is not suitable for the treatment of target systolic blood pressure for the treatment of patients with high blood pressure in my country.
In order to further study this problem, cardiovascular experts from the National Cardiovascular Disease Center and the Fuwai Hospital of the Chinese Academy of Medical Sciences have conducted a study called STEP, which aims to enable patients with senior high blood pressure in my country to achieve more heart and brain Benefit. Recently, the relevant results were published in Nejm magazines.
In this multi-center random control test, researchers allocate Chinese hypertension patients aged 60 to 80 to 110-130mmHg systolic blood pressure target (strengthening therapy) or 130-150mmHg target (standard treatment). The main results were comprehensive incidence of stroke, acute coronary arterial syndrome (acute myocardial infarction and unstable angina pectoris), acute dislocated cardiac heart failure, coronary blood transportation, atrial fibrillation or cardiovascular causes.
Among the 9,624 patients were screened, 8511 people participated in the test; 4243 people were randomly assigned to the intensive treatment group, and 4268 were allocated to the standard treatment group. During the one -year follow -up, the average systolic blood pressure of the strengthening therapy group was 127.5mmHg, and the standard therapy group was 135.3mmHg. The diastolic blood pressure in the two groups was 76.4 mmHg and 79.2 mmHg, respectively.
During the median follow -up of 3.34 years, there were 147 patients (3.5%) in the intensive therapy group (3.5%), and the standard therapy group had 196 patients (4.6%). 95%CI: 0.60-0.92). The results of most single components in the main results are also conducive to strengthening treatment: the risk of stroke is reduced by 33%(HR = 0.67; 95%CI, 0.47-0.97), and the acute coronary arterial syndrome is reduced by 33%(HR = 0.67; 95%CI, 0.47-0. 94), the acute disorderly paid compensation heart failure decreased by 73%(HR = 0.27, 95%CI, 0.08-0.98).
However, coronary blood transportation (HR = 0.69, 95%CI, 0.40-1.18), atrial fibrillation (HR = 0.96; 95%CI, 0.55-1.68), and cardiovascular causes (HR = 0.72; 95; 95; 95; 95; 95; 95; 95; 95; 95; %CI, 0.39-1.32). In addition, except for the higher blood pressure incidence, the safety of the two groups is not significantly different from the higher the treatment group.
In summary, the large -scale STEP test provides important evidence, indicating that the reduction of the shrinkage to below 130 mmHg can bring cardiovascular benefits to the elderly patients in China.
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references:
TRIAL of Intensive Blood-Pressure Control in Older Patients with Hypertension. August 30, 2021. Doi: 10.1056/nejmoa2111437
