高血压患者治疗后平均血压水平与心脑血管事件的关系--非洛地平降低并发症研究分析  

Relationship between Blood Pressure Level and Endpoint Events in Patients with Hypertension in China:the Felodipine Event Reduction Trial

作　　者：王文[1] 张宇清[1] 张学中[1] 张善同[1] 唐新华[1] 陈涛[1] 周景春[1] 张亮清[1] 张廷杰[1] 孙明[1] 王云献[1] 齐德仁[1] 王宪衍[1] 刘力生[1] 

机构地区：[1]国家心血管病中心,中国医学科学院阜外心血管病医院,北京高血压联盟研究所,北京100037

出　　处：《中华高血压杂志》2010年第5期439-443,共5页Chinese Journal of Hypertension

基　　金：国家九五攻关课题

摘　　要：背景高血压降压治疗是否存在"J"形曲线仍有争议,主要问题是降低血压水平是否增加心脏事件。目的了解中国高血压患者治疗3.3年后平均血压水平与终点事件的关系,并了解血压有无"J"形曲线。方法非洛地平降低并发症研究(FEVER)是随机安慰剂对照临床试验,治疗9711例高血压患者。将平均治疗3.3年后收缩压分为5级:<120,120～129,130～139,140～149,≥150mmHg;舒张压分为4级:<70,70～79,80～89,≥90mmHg。分析治疗后不同血压级别与脑卒中、心脏事件、心血管病死亡、总心血管事件和总死亡发生频率的关系。结果 9711例患者,治疗后平均收缩压130～149mmHg者占68%,舒张压70～89mmHg者占83%。总的脑卒中发生率是心脏事件的3倍,心血管病死亡占总死亡的66%。脑卒中、心脏事件、心血管病死亡、总心血管事件及总死亡均随治疗3.3年后平均收缩压及舒张压水平的下降而减少。收缩压<120mmHg或舒张压<70mmHg时终点事件及总死亡率最低,未见到"J"形曲线。结论研究终点事件及死亡率随治疗3.3年后平均血压水平逐步降低而减少,血压降至<120/70mmHg仍有益。Background The existence of the J-curve phenominan in hypertension treatment remains unverified.The major controvercy falls on whether the increase in heart event is induced by the lowering of blood pressure.Objective To explore the relationship between blood pressure level and the endpoint events after 3.3 years treatment,and to observe whether J curve exists in patients with hypertension in FEVER trial.Methods Nine thosand seven hundred eleven participants in felodipine event reduction（FEVER）study were randomized.Systolic blood pressure（SBP）at the end of the treatment was classified into 5 levels as SBP120,120-129,130-139,140-149 and ≥150 mm Hg;and diastolic blood pressure（DBP）was classified into 4 levels as 70,70-79,80-89,and ≥90 mm Hg.The relationship between each blood pressure level and stroke,heart diseases,cardiovascular death,total cardiovascular events and all-causes mortality was analysed.Results At the end of treatment,the percentage of those whose SBP fell on 130-149 mm Hg was 68%,and those whose DBP fell on 70-89 mm Hg was 83%.Stroke,heart disease,cardiovascular death,total cardiovascular events,and all-causes mortality decreased with SBP and DBP the lowering of level after 3.3 years treatment.Study endpoint events and all-causes mortality were lowest in the subgroup or BP 120 or 70 mm Hg,no J curve was observed.Conclusion Study endpoint events and all-causes mortality reduced with mean blood pressure level lowering after 3.3 years treatment;the benefit still existed even when blood pressure remained at lower than 120/70 mm Hg.

关 键 词：高血压 血压 心血管事件 关系 

分 类 号：R544.1[医药卫生—心血管疾病]