-
Tytuł:
-
Intensive vs Standard Blood Pressure Control and Cardiovascular Disease Outcomes in Adults Aged ≥75 Years: A Randomized Clinical Trial.
-
Autorzy:
-
Williamson, Jeff D.
Supiano, Mark A.
Applegate, William B.
Berlowitz, Dan R.
Campbell, Ruth C.
Chertow, Glenn M.
Fine, Larry J.
Haley, William E.
Hawfield, Amret T.
Ix, Joachim H.
Kitzman, Dalane W.
Kostis, John B.
Krousel-Wood, Marie A.
Launer, Lenore J.
Oparil, Suzanne
Rodriguez, Carlos J.
Roumie, Christianne L.
Shorr, Ronald I.
Sink, Kaycee M.
Wadley, Virginia G.
-
Temat:
-
ANTIHYPERTENSIVE agents
MYOCARDIAL infarction-related mortality
BLOOD pressure
BLOOD pressure measurement
COMPARATIVE studies
CAUSES of death
HEART failure
HYPERTENSION
RESEARCH methodology
MEDICAL cooperation
RESEARCH
RESEARCH funding
EVALUATION research
RANDOMIZED controlled trials
ACUTE coronary syndrome
DISEASE complications
-
Źródło:
-
JAMA: Journal of the American Medical Association. 6/28/2016, Vol. 315 Issue 24, p2673-2682. 10p.
-
Importance: The appropriate treatment target for systolic blood pressure (SBP) in older patients with hypertension remains uncertain.Objective: To evaluate the effects of intensive (<120 mm Hg) compared with standard (<140 mm Hg) 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 120 mm Hg (intensive treatment group, n = 1317) or an SBP target of less than 140 mm Hg (standard treatment group, n = 1319).Main Outcomes and Measures: The primary cardiovascular disease outcome was a composite of nonfatal myocardial 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 120 mm Hg compared with an SBP target of less than 140 mm Hg resulted in significantly lower rates of fatal and nonfatal major cardiovascular events and death from any cause.Trial Registration: clinicaltrials.gov Identifier: NCT01206062. [ABSTRACT FROM AUTHOR]
Copyright of JAMA: Journal of the American Medical Association is the property of American Medical Association and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)