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    Home > Biochemistry News > Biotechnology News > NEJM: Prevention of myocardial infarction and life extension test confirmed that systolic blood pressure <120mmHg is better

    NEJM: Prevention of myocardial infarction and life extension test confirmed that systolic blood pressure <120mmHg is better

    • Last Update: 2021-06-01
    • Source: Internet
    • Author: User
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    Hypertension affects approximately 1 billion adults worldwide.
    Hypertension is also a risk factor for myocardial infarction, heart failure, stroke, chronic kidney disease and cognitive decline.
    In people ≥50 years of age, isolated systolic hypertension is the most common form of hypertension, and systolic blood pressure has a more obvious effect than diastolic blood pressure in predicting coronary heart disease, stroke, heart failure, end-stage renal disease and other events.

    However, in the hypertensive population, the extent to which the systolic blood pressure should be reduced has been continuously discussed over the years.
    Generally, systolic blood pressure <140 mmHg is a common treatment target, and whether intensive blood pressure control with systolic blood pressure <120 mmHg is beneficial is an important question.

    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.
    Cora E.
    Lewis, a professor of epidemiology at the University of Alabama, said that this study supports and reinforces previous findings and shows that blood pressure control is "the lower the better.
    "

    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.
    They have no history of diabetes or stroke.
    But the risk of cardiovascular disease has increased.

    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.
    73m2;

    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.
    Pressure target.

    The main outcome is myocardial infarction, or other composite indicators of acute coronary syndrome, stroke, acute compensatory heart failure, or death from cardiovascular causes.
    The paper published this time analyzed the main outcome events after the intervention ended on August 20, 2015, and the observational follow-up data as of July 29, 2016.
    The median follow-up time was 3.
    3 years.

    Significantly improve the risk of cardiovascular disease and death

    Significantly improve the risk of cardiovascular disease and death

    During 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.
    77% vs 2.
    40%), and the risk of all-cause death was also significantly lower by 25% (annual mortality rate 1.
    06 % vs 1.
    41%).
    This is similar to the early preliminary results of the SPRINT study.

    ▲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%.
    Myocardial infarction (28% reduction), heart failure (37% reduction), and cardiovascular mortality (42% reduction) were significantly lower in the intensive antihypertensive treatment group.
    Subgroup analysis also supports the benefit of intensive antihypertensive therapy.

    Stronger evidence

    Stronger evidence

    Previously, 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.
    Some critics believe that the evidence for heart failure is not sufficient because it is difficult to diagnose heart failure from the records of clinical trials.
    More subjects in the intensive antihypertensive treatment group received diuretics, which would relieve swelling.
    And this is a key symptom of heart failure.
    Dr.
    Lewis particularly emphasized that these final results provide stronger evidence.
    After excluding heart failure, multiple indicator gaps unanimously support the benefits of enhanced blood pressure reduction.

    Moreover, this analysis based on the intervention expectations and all the data in the subsequent observation period also supports the above conclusions.
    In addition, the intensive antihypertensive treatment group had significantly fewer primary and recurring primary outcomes (435 cases vs.
    552 cases), and the risk was reduced by 22%.

    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.
    In the past year, the systolic blood pressure of the intensive antihypertensive treatment group and the standard treatment group increased by 6.
    9 mm Hg and 2.
    6 mm Hg, respectively.
    Dr.
    Lewis added, "Comprehensive analysis of the data in the trial phase and the actual situation shows that intensive antihypertensive therapy still shows a clear advantage in improving health outcomes.
    "

    Safe and controllable medication

    Safe and controllable medication

    During the intervention period, there was no significant difference in the overall incidence of serious adverse events between the two groups.
    However, in the intensive treatment group, the incidence of hypotension, electrolyte abnormalities, syncope (none of which did not cause falls), and acute kidney injury were higher.

    "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, from Systolic Blood Pressure Intervention Trial (SPRINT) Study.
    Retrieved May 21, 2021, from The SPRINT Research Group.
    (2015).
    A Randomized Trial of Intensive versus Standard Blood-Pressure Control.
    The N Engl J Med, DOI: 10.
    1056/NEJMoa1511939

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