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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 Whether there is a “J” -shaped curve in the treatment of hypotensive hypotension remains controversial. The main issue is whether lowering blood pressure increases cardiac events. Objective To understand the relationship between mean blood pressure and end point in Chinese patients with hypertension after 3.3 years of treatment and to find out whether there is a “J” -shaped curve of blood pressure. Methods Felodipine reduces complications (FEVER) is a randomized, placebo-controlled clinical trial of 9711 patients with hypertension. The average treatment of 3.3 years after the systolic blood pressure is divided into five levels: <120,120 ~ 129,130 ~ 139,140 ~ 149, ≥ 150mmHg; diastolic blood pressure is divided into four grades: <70,70 ~ 79,80 ~ 89, ≥ 90mmHg. The relationship between different blood pressure levels and the incidence of stroke, cardiac events, cardiovascular deaths, total cardiovascular events, and overall mortality was analyzed. Results 9711 patients, after treatment, the average systolic blood pressure of 130 ~ 149mmHg accounted for 68%, diastolic blood pressure of 70 ~ 89mmHg accounted for 83%. The overall incidence of stroke is three times as high as that of a heart attack, and cardiovascular deaths account for 66% of all deaths. Stroke, cardiac events, cardiovascular deaths, total cardiovascular events, and overall death decreased with mean systolic and diastolic blood pressure levels after 3.3 years of treatment. Systolic blood pressure <120mmHg or diastolic blood pressure <70mmHg end point and the lowest total mortality, did not see “J ” -shaped curve. Conclusions The study end point and mortality decreased with decreasing mean blood pressure level after 3.3 years of treatment. It is still beneficial to lower the blood pressure to <120 / 70mmHg.