不同血压靶目标值对心血管事件影响的Meta分析
摘要
目的系统评价不同血压靶目标值对心血管事件的影响。方法计算机检索PubMed、EmBase、Cochrane图书馆、中国知网、中国生物医学文献数据库(CBM)等中英文数据库,筛选不同血压靶目标值对心血管事件影响的随机对照试验,运用RveMan 5.3软件对纳入资料进行Meta分析。结果共纳入7项随机对照试验,共32 315例病人。与标准降压(<140/90 mmHg)比较,强化降压(<130/80 mmHg)心肌梗死风险比(HR)为0.84,卒中HR为0.82,心力衰竭HR为0.77,并未发现强化降压降低或增加全因死亡及心血管死亡的风险。结论强化降压与标准降压相比,可降低心肌梗死、卒中、心力衰竭的风险。
引文
[1] LEWINGTON S,CLARKE R,QIZILBASH N,et al.Age specific relevance of usual blood pressure to vascular mortality:a meta analysis of individual data for one million adults in 61prospective studies[J].Lancet,2002,360(9349):1903-1913.
[2] BUNDY J D,LI C,STUCHLIK P,et al.Systolic blood pressure reduction and risk of cardiovascular disease and mortality:a systematic review and network meta-analysis[J].JAMA Cardiol,2017,2(7):775-781.
[3] BANGALORE S,TOKLU B,GIANOS E,et al.Optimal systolic blood pressure target after SPRINT insights from a network meta-analysis of randomized trials[J].The American Journal of Medicine,2017,130(6):707-719.
[4] BANGALORE S,KUMAR S,LOBACH I,et al.Blood pressure targets in subjects with type 2 diabetes mellitus/impaired fasting glucose:observations from traditional and Bayesian random-effects meta-analyses of randomized trials[J].Circulation,2011,123(24):2799-2810.
[5] WRIGHT J J,BAKRIS G,GREENE T,et al.Effect of blood pressure lowering and antihypertensive drug class on progression of hypertensive kidney disease:results from the AASK trial[J].JAMA,2002.288(19):2421-2431.
[6] ESTACIO R O,JEFFERS B W,GIFFORD N,et al.Effect of blood pressure control on diabetic microvascular complications in patients with hypertension and type 2 diabetes[J].Diabetes Care,2000,23(1):B54.
[7] CUSHMAN W C.Effects of intensive blood-pressure control in type 2 diabetes mellitus[J].The New England Journal of Medicine,2010,362(17):1575-1585.
[8] VERDECCHIA P,STAESSEN J A,ANGELI F,et al.Usual versus tight control of systolic blood pressure in non-diabetic patients with hypertension (Cardio-Sis):an open-label randomised trial[J].Lancet,2009,374(9689):525-533.
[9] HANSSON L,ZANCHETTI A,CARRUTHERS S G,et al.Effects of intensive blood-pressure lowering and low-dose aspirin in patients with hypertension:principal results of the Hypertension Optimal Treatment (HOT) randomised trial.HOT Study Group[J].Lancet,1998,351(9118):1755-1762.
[10] GROUP S R,WRIGHT J J,WILLIAMSON J D,et al.A randomized trial of intensive versus standard blood-pressure control[J].The New England Journal of Medicine,2015,373(22):2103-2116.
[11] SPS3 Study Group,BENAVENTE O R,COFFEY C S,et al.Blood-pressure targets in patients with recent lacunar stroke:the SPS3 randomised trial[J].The Lancet,2013,382(9891):507-515.
[12] FEI Y,TSOI MF,CHEUNG B M Y.Determining the optimal systolic blood pressure for hypertensive patients:a network meta-analysis[J].Canadian Journal of Cardiology,2018,34(12):1581-1589.
[13] ARGUEDAS J A,PEREZ M I,WRIGHT J M.Treatment blood pressure targets for hypertension[J].Cochrane Database of Systematic Reviews,2003,3(3):CD004349.
[14] ETTEHAD D,EMDIN C A,KIRAN A,et al.Blood pressure lowering for prevention of cardiovascular disease and death:a systematic review and meta-analysis[J].Lancet,2016,387(10022):957-967.
[2] BUNDY J D,LI C,STUCHLIK P,et al.Systolic blood pressure reduction and risk of cardiovascular disease and mortality:a systematic review and network meta-analysis[J].JAMA Cardiol,2017,2(7):775-781.
[3] BANGALORE S,TOKLU B,GIANOS E,et al.Optimal systolic blood pressure target after SPRINT insights from a network meta-analysis of randomized trials[J].The American Journal of Medicine,2017,130(6):707-719.
[4] BANGALORE S,KUMAR S,LOBACH I,et al.Blood pressure targets in subjects with type 2 diabetes mellitus/impaired fasting glucose:observations from traditional and Bayesian random-effects meta-analyses of randomized trials[J].Circulation,2011,123(24):2799-2810.
[5] WRIGHT J J,BAKRIS G,GREENE T,et al.Effect of blood pressure lowering and antihypertensive drug class on progression of hypertensive kidney disease:results from the AASK trial[J].JAMA,2002.288(19):2421-2431.
[6] ESTACIO R O,JEFFERS B W,GIFFORD N,et al.Effect of blood pressure control on diabetic microvascular complications in patients with hypertension and type 2 diabetes[J].Diabetes Care,2000,23(1):B54.
[7] CUSHMAN W C.Effects of intensive blood-pressure control in type 2 diabetes mellitus[J].The New England Journal of Medicine,2010,362(17):1575-1585.
[8] VERDECCHIA P,STAESSEN J A,ANGELI F,et al.Usual versus tight control of systolic blood pressure in non-diabetic patients with hypertension (Cardio-Sis):an open-label randomised trial[J].Lancet,2009,374(9689):525-533.
[9] HANSSON L,ZANCHETTI A,CARRUTHERS S G,et al.Effects of intensive blood-pressure lowering and low-dose aspirin in patients with hypertension:principal results of the Hypertension Optimal Treatment (HOT) randomised trial.HOT Study Group[J].Lancet,1998,351(9118):1755-1762.
[10] GROUP S R,WRIGHT J J,WILLIAMSON J D,et al.A randomized trial of intensive versus standard blood-pressure control[J].The New England Journal of Medicine,2015,373(22):2103-2116.
[11] SPS3 Study Group,BENAVENTE O R,COFFEY C S,et al.Blood-pressure targets in patients with recent lacunar stroke:the SPS3 randomised trial[J].The Lancet,2013,382(9891):507-515.
[12] FEI Y,TSOI MF,CHEUNG B M Y.Determining the optimal systolic blood pressure for hypertensive patients:a network meta-analysis[J].Canadian Journal of Cardiology,2018,34(12):1581-1589.
[13] ARGUEDAS J A,PEREZ M I,WRIGHT J M.Treatment blood pressure targets for hypertension[J].Cochrane Database of Systematic Reviews,2003,3(3):CD004349.
[14] ETTEHAD D,EMDIN C A,KIRAN A,et al.Blood pressure lowering for prevention of cardiovascular disease and death:a systematic review and meta-analysis[J].Lancet,2016,387(10022):957-967.