Intensive vs Standard Blood Pressure Control and Cardiovascular Disease Outcomes in Adults Aged ≥75 Years A Randomized Clinical Trial

被引：903

作者：

Williamson, Jeff D. ^{[1
]}

Supiano, Mark A. ^{[2
,3
]}

Applegate, William B. ^{[1
]}

Berlowitz, Dan R. ^{[4
,5
]}

Campbell, Ruth C. ^{[6
]}

Chertow, Glenn M. ^{[7
]}

Fine, Larry J. ^{[8
]}

Haley, William E. ^{[9
]}

Hawfield, Amret T. ^{[10
]}

Ix, Joachim H. ^{[11
,12
,13
]}

Kitzman, DalaneW. ^{[14
]}

Kostis, John B. ^{[15
]}

Krousel-Wood, Marie A. ^{[16
,17
,18
]}

Launer, Lenore J. ^{[19
]}

Oparil, Suzanne ^{[20
]}

Rodriguez, Carlos J. ^{[21
]}

Roumie, Christianne L. ^{[22
,23
]}

Shorr, Ronald I. ^{[24
,25
]}

Sink, Kaycee M. ^{[1
]}

Wadley, Virginia G. ^{[26
]}

Whelton, Paul K. ^{[27
]}

Whittle, Jeffrey ^{[28
,29
]}

Woolard, Nancy F. ^{[1
]}

Wright, Jackson T., Jr. ^{[30
]}

Pajewski, Nicholas M.

机构：

[1] Wake Forest Sch Med, Med Ctr Blvd, Sect Gerontol & Geriatr Med, Winston Salem, NC 27157 USA

[2] Univ Utah, Sch Med, Div Geriatr, Salt Lake City, UT USA

[3] Vet Affairs Salt Lake City, Geriatr Res Educ & Clin Ctr, Salt Lake City, UT USA

[4] Bedford Vet Affairs Hosp, Bedford, MA USA

[5] Boston Univ, Sch Publ Hlth, Boston, MA USA

[6] Med Univ S Carolina, Dept Med, Charleston, SC 29425 USA

[7] Stanford Univ, Sch Med, Dept Med, Palo Alto, CA 94304 USA

[8] NHLBI, Div Cardiovasc Sci, Clin Applicat & Prevent Branch, Bldg 10, Bethesda, MD 20892 USA

[9] Mayo Clin, Dept Hypertens & Nephrol, Jacksonville, FL 32224 USA

[10] Wake Forest Sch Med, Nephrol Sect, Winston Salem, NC USA

[11] Univ Calif San Diego, Dept Med, Div Nephrol & Hypertens, San Diego, CA 92103 USA

[12] Univ Calif San Diego, Dept Family Med & Publ Hlth, Div Prevent Med, San Diego, CA 92103 USA

[13] Vet Affairs San Diego Healthcare Syst, Dept Med, Nephrol Sect, San Diego, CA USA

[14] Wake Forest Sch Med, Sect Cardiovasc Med, Winston Salem, NC USA

[15] Univ Med & Dent New Jersey, Robert Wood Johnson Med Sch, Cardiovasc Inst Rutgers, New Brunswick, NJ USA

[16] Tulane Univ, Sch Med, Dept Med, New Orleans, LA 70112 USA

[17] Tulane Univ, Dept Epidemiol, Sch Publ Hlth & Trop Med, New Orleans, LA 70118 USA

[18] Ochsner Clin Fdn, Ctr Appl Hlth Res, New Orleans, LA USA

[19] NIA, Intramural Res Program, Bethesda, MD 20892 USA

[20] Univ Alabama Birmingham, Dept Med, Div Cardiovasc Dis, Birmingham, AL 35294 USA

[21] Wake Forest Sch Med, Dept Epidemiol & Prevent, Div Publ Hlth Sci, Winston Salem, NC USA

[22] HSR&D Ctr, Vet Hlth Adm Tennessee Valley Healthcare Syst Ger, Nashville, TN USA

[23] Vanderbilt Univ, Dept Med, Nashville, TN USA

[24] Univ Florida, Dept Epidemiol, Gainesville, FL USA

[25] Malcom Randall Vet Adm Med Ctr, Geriatr Res Educ & Clin Ctr, Gainesville, FL USA

[26] Univ Alabama Birmingham, Dept Med, Birmingham, AL 35294 USA

[27] Tulane Univ, Sch Publ Hlth & Trop Med, Dept Epidemiol, New Orleans, LA USA

[28] Med Coll Wisconsin, Dept Med, Milwaukee, WI 53226 USA

[29] Clement J Zablocki Vet Affairs Med Ctr, Primary Care Div, Milwaukee, WI USA

[30] Case Western Reserve Univ, Dept Med, Div Nephrol & Hypertens, Cleveland, OH 44106 USA

来源：

JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION | 2016年 / 315卷 / 24期

基金：

美国国家卫生研究院;

关键词：

ANTIHYPERTENSIVE TREATMENT; OLDER-PEOPLE; HYPERTENSION; FRAILTY; GUIDELINES; EVENTS; STROKE; FALLS; INDEX; RISK;

D O I：

10.1001/jama.2016.7050

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

IMPORTANCE The appropriate treatment target for systolic blood pressure (SBP) in older patients with hypertension remains uncertain. OBJECTIVE To evaluate the effects of intensive (<120mmHg) compared with standard (<140mmHg) SBP targets in persons aged 75 years or older with hypertension but without diabetes. DESIGN, SETTING, AND PARTICIPANTS A multicenter, randomized clinical trial of patients aged 75 years or older who participated in the Systolic Blood Pressure Intervention Trial (SPRINT). Recruitment began on October 20, 2010, and follow-up ended on August 20, 2015. INTERVENTIONS Participants were randomized to an SBP target of less than 120mmHg (intensive treatment group, n = 1317) or an SBP target of less than 140mmHg (standard treatment group, n = 1319). MAIN OUTCOMES AND MEASURES The primary cardiovascular disease outcomewas a composite of nonfatalmyocardial infarction, acute coronary syndrome not resulting in a myocardial infarction, nonfatal stroke, nonfatal acute decompensated heart failure, and death from cardiovascular causes. All-cause mortality was a secondary outcome. RESULTS Among 2636 participants (mean age, 79.9 years; 37.9% women), 2510 (95.2%) provided complete follow-up data. At a median follow-up of 3.14 years, there was a significantly lower rate of the primary composite outcome (102 events in the intensive treatment group vs 148 events in the standard treatment group; hazard ratio [HR], 0.66 [95% CI, 0.51-0.85]) and all-cause mortality (73 deaths vs 107 deaths, respectively; HR, 0.67 [95% CI, 0.49-0.91]). The overall rate of serious adverse events was not different between treatment groups (48.4% in the intensive treatment group vs 48.3% in the standard treatment group; HR, 0.99 [95% CI, 0.89-1.11]). Absolute rates of hypotension were 2.4% in the intensive treatment group vs 1.4% in the standard treatment group (HR, 1.71 [95% CI, 0.97-3.09]), 3.0% vs 2.4%, respectively, for syncope (HR, 1.23 [95% CI, 0.76-2.00]), 4.0% vs 2.7% for electrolyte abnormalities (HR, 1.51 [95% CI, 0.99-2.33]), 5.5% vs 4.0% for acute kidney injury (HR, 1.41 [95% CI, 0.98-2.04]), and 4.9% vs 5.5% for injurious falls (HR, 0.91 [95% CI, 0.65-1.29]). CONCLUSIONS AND RELEVANCE Among ambulatory adults aged 75 years or older, treating to an SBP target of less than 120mmHg compared with an SBP target of less than 140mmHg resulted in significantly lower rates of fatal and nonfatal major cardiovascular events and death from any cause.

引用

页码：2673 / 2682

页数：10

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