Trial of Intensive Blood-Pressure Control in Older Patients with Hypertension
| Autor: | Weili, Zhang, Shuyuan, Zhang, Yue, Deng, Shouling, Wu, Jie, Ren, Gang, Sun, Jinfeng, Yang, Yinong, Jiang, Xinjuan, Xu, Tzung-Dau, Wang, Youren, Chen, Yufeng, Li, Lianchen, Yao, Dianfang, Li, Lixin, Wang, Xiaomei, Shen, Xinhua, Yin, Wei, Liu, Xiaoyang, Zhou, Bingpo, Zhu, Zihong, Guo, Hualing, Liu, Xiaoping, Chen, Yingqing, Feng, Gang, Tian, Xiuyin, Gao, Kazuomi, Kario, Jun, Cai, Luyun, Fan |
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| Rok vydání: | 2021 |
| Předmět: |
Male
medicine.medical_specialty Systole Blood Pressure law.invention Geriatric cardiology Randomized controlled trial Older patients law Internal medicine Epidemiology medicine Humans Antihypertensive Agents Preventive healthcare Aged Aged 80 and over business.industry Incidence (epidemiology) Incidence Standard of Care General Medicine Middle Aged Blood pressure Cardiovascular Diseases Hypertension Cardiology Female Hypotension business |
| Zdroj: | The New England journal of medicine. 385(14) |
| ISSN: | 1533-4406 |
| Popis: | The appropriate target for systolic blood pressure to reduce cardiovascular risk in older patients with hypertension remains unclear.In this multicenter, randomized, controlled trial, we assigned Chinese patients 60 to 80 years of age with hypertension to a systolic blood-pressure target of 110 to less than 130 mm Hg (intensive treatment) or a target of 130 to less than 150 mm Hg (standard treatment). The primary outcome was a composite of stroke, acute coronary syndrome (acute myocardial infarction and hospitalization for unstable angina), acute decompensated heart failure, coronary revascularization, atrial fibrillation, or death from cardiovascular causes.Of the 9624 patients screened for eligibility, 8511 were enrolled in the trial; 4243 were randomly assigned to the intensive-treatment group and 4268 to the standard-treatment group. At 1 year of follow-up, the mean systolic blood pressure was 127.5 mm Hg in the intensive-treatment group and 135.3 mm Hg in the standard-treatment group. During a median follow-up period of 3.34 years, primary-outcome events occurred in 147 patients (3.5%) in the intensive-treatment group, as compared with 196 patients (4.6%) in the standard-treatment group (hazard ratio, 0.74; 95% confidence interval [CI], 0.60 to 0.92; P = 0.007). The results for most of the individual components of the primary outcome also favored intensive treatment: the hazard ratio for stroke was 0.67 (95% CI, 0.47 to 0.97), acute coronary syndrome 0.67 (95% CI, 0.47 to 0.94), acute decompensated heart failure 0.27 (95% CI, 0.08 to 0.98), coronary revascularization 0.69 (95% CI, 0.40 to 1.18), atrial fibrillation 0.96 (95% CI, 0.55 to 1.68), and death from cardiovascular causes 0.72 (95% CI, 0.39 to 1.32). The results for safety and renal outcomes did not differ significantly between the two groups, except for the incidence of hypotension, which was higher in the intensive-treatment group.In older patients with hypertension, intensive treatment with a systolic blood-pressure target of 110 to less than 130 mm Hg resulted in a lower incidence of cardiovascular events than standard treatment with a target of 130 to less than 150 mm Hg. (Funded by the Chinese Academy of Medical Sciences and others; STEP ClinicalTrials.gov number, NCT03015311.). |
| Databáze: | OpenAIRE |
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