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Hypertension affects approximately 1 billion adults worldwide.
However, in the hypertensive population, the extent to which the systolic blood pressure should be reduced has been continuously discussed over the years.
Today, the "New England Journal of Medicine" recently published the final results of the milestone study SPRINT (systolic blood pressure intervention trial), confirming that intensive blood pressure management and systolic blood pressure below 120 mmHg can significantly reduce the risk of heart disease, stroke and death.
The lead researcher, Dr.
The SPRINT study is supported by the National Heart, Lung and Blood Institute (NHLBI), and aims to answer three important questions: If the systolic blood pressure is controlled to <120 mmHg, what will be the impact on the cardiovascular system, kidneys, and brain, respectively?
Regarding the impact on the cardiovascular system, this trial included 9361 adults 50 years and older with a systolic blood pressure between 130 mmHg and 180 mmHg between November 2010 and March 2013.
Increased risk of cardiovascular disease is defined as meeting one or more of the following:
Suffer from clinical or subclinical cardiovascular disease (except stroke);
Suffer from chronic kidney disease (except polycystic kidney disease), eGFR level is 20 ~ <60 ml/min/1.
According to the Framingham risk score, the 10-year risk of cardiovascular disease is ≥15%;
≥75 years old.
The subjects were randomly divided into groups to receive intensive antihypertensive therapy (target systolic blood pressure <120 mm Hg) or standard antihypertensive therapy (target systolic blood pressure <140 mm Hg), and adjusted the antihypertensive regimen according to the actual situation to ensure that the antihypertensive treatment was achieved.
The main outcome is myocardial infarction, or other composite indicators of acute coronary syndrome, stroke, acute compensatory heart failure, or death from cardiovascular causes.
Significantly improve the risk of cardiovascular disease and death
Significantly improve the risk of cardiovascular disease and deathDuring the trial intervention period, in terms of blood pressure control, the difference in systolic blood pressure quickly appeared between the two groups of patients, and it persisted as expected.
Analyzing the outcome events that occurred during the intervention period, the data showed that the risk of the main outcome event in the intensive antihypertensive treatment group was significantly reduced by 27% (annual incidence rate 1.
▲During the intervention period, in the quarterly follow-up, the incidence of major outcome events in the intensive antihypertensive treatment group was lower (picture source: reference [1])
Even after excluding non-fatal heart failure, intensive antihypertensive treatment improved the other main outcomes similarly, and the risk was significantly reduced by 25%.
Stronger evidence
Stronger evidencePreviously, the early results of the SPRINT study have also been questioned by the industry: intensive antihypertensive therapy improves the outcome of cardiovascular disease, mainly in heart failure and cardiovascular death.
Moreover, this analysis based on the intervention expectations and all the data in the subsequent observation period also supports the above conclusions.
After the trial intervention period ended, the subjects' blood pressure treatment returned to routine treatment and no longer adhered to the treatment goals in the trial.
Safe and controllable medication
Safe and controllable medicationDuring the intervention period, there was no significant difference in the overall incidence of serious adverse events between the two groups.
"The degree of acute kidney injury is usually mild, and renal function is almost completely restored within one year.
Combined with other analyses, this may be a hemodynamic effect.
" Dr.
Lewis explained, "Intensive antihypertensive therapy can be well tolerated.
Choose the right one.
Of patients, plus monitoring, is usually safe.
I think these adverse event risks are not enough to make us abandon intensive antihypertensive therapy.
"
Note: The original text has been deleted
Reference
[1] The SPRINT Research Group.
(2021).
Final Report of a Trial of Intensive versus Standard Blood-Pressure Control.
The N Engl J Med, DOI: 10.
1056/NEJMoa1901281
[2] Final SPRINT Data Confirm Lower BP Is Better.
Retrieved May 21, 2021, fromSystolic Blood Pressure Intervention Trial (SPRINT) Study.
Retrieved May 21, 2021, fromThe SPRINT Research Group.
(2015).
A Randomized Trial of Intensive versus Standard Blood-Pressure Control.
The N Engl J Med, DOI: 10.
1056/NEJMoa1511939