【medical-news】The Lancet：在新发腔隙性脑梗患者中应将收缩压控制在130mmHg以下
这个帖子发布于 12 年零 10 天前，其中的信息可能已发生改变或有所发展。
Blood-pressure targets in patients with recent lacunar stroke: the SPS3randomised trial
TheSPS3 Study Group*
Summary
Background Lowering of blood pressure prevents stroke butoptimum target levels to prevent recurrent stroke are unknown. We investigatedthe effects of different blood-pressure targets on the rate of recurrent strokein patientswith recent lacunar stroke.
Methods In this randomised open-label trial, eligiblepatients lived in North America, Latin America, and Spain and had recent,MRI-defined symptomatic lacunar infarctions. Patients were recruited betweenMarch, 2003, and April, 2011, and randomly assigned, according to a two-by-twomultifactorial design, to a systolic-blood-pressure target of 130–149 mm Hg or less than 130 mmHg. The primary endpoint was reduction in all stroke (including ischaemic strokesand intracranial haemorrhages). Analysis was done by intention to treat. Thisstudy is registered with ClinicalTrials.gov, number NCT 00059306.
Findings 3020 enrolled patients, 1519 in the higher-targetgroup and 1501 in the lower-target group, were followed up for a mean of 3·7 (SD 2·0) years. Mean age was 63 (SD 11) years. After 1 year, mean systolicblood pressure was 138 mm Hg (95% CI 137–139) in thehigher-target group and 127 mm Hg (95% CI 126–128) inthe lower-target group. Non-signifi cant rate reductions were seen for allstroke (hazard ratio 0·81, 95% CI 0·64–1·03, p=0·08), disabling or fatal stroke (0·81, 0·53–1·23, p=0·32), and the composite outcome of myocardial infarction or vasculardeath (0·84, 0·68–1·04, p=0·32) withthe lower target. The rate of intracerebral haemorrhage was reduced significantly(0·37, 0·15–0·95, p=0·03).Treatment-related serious adverse events were infrequent.
Interpretation Although the reduction in stroke was not significant, our results support that in patients with recent lacunar stroke, the useof a systolic-blood-pressure target of less than 130 mm Hg is likely to bebenefi cial.
TheSPS3 Study Group*
Summary
Background Lowering of blood pressure prevents stroke butoptimum target levels to prevent recurrent stroke are unknown. We investigatedthe effects of different blood-pressure targets on the rate of recurrent strokein patientswith recent lacunar stroke.
Methods In this randomised open-label trial, eligiblepatients lived in North America, Latin America, and Spain and had recent,MRI-defined symptomatic lacunar infarctions. Patients were recruited betweenMarch, 2003, and April, 2011, and randomly assigned, according to a two-by-twomultifactorial design, to a systolic-blood-pressure target of 130–149 mm Hg or less than 130 mmHg. The primary endpoint was reduction in all stroke (including ischaemic strokesand intracranial haemorrhages). Analysis was done by intention to treat. Thisstudy is registered with ClinicalTrials.gov, number NCT 00059306.
Findings 3020 enrolled patients, 1519 in the higher-targetgroup and 1501 in the lower-target group, were followed up for a mean of 3·7 (SD 2·0) years. Mean age was 63 (SD 11) years. After 1 year, mean systolicblood pressure was 138 mm Hg (95% CI 137–139) in thehigher-target group and 127 mm Hg (95% CI 126–128) inthe lower-target group. Non-signifi cant rate reductions were seen for allstroke (hazard ratio 0·81, 95% CI 0·64–1·03, p=0·08), disabling or fatal stroke (0·81, 0·53–1·23, p=0·32), and the composite outcome of myocardial infarction or vasculardeath (0·84, 0·68–1·04, p=0·32) withthe lower target. The rate of intracerebral haemorrhage was reduced significantly(0·37, 0·15–0·95, p=0·03).Treatment-related serious adverse events were infrequent.
Interpretation Although the reduction in stroke was not significant, our results support that in patients with recent lacunar stroke, the useof a systolic-blood-pressure target of less than 130 mm Hg is likely to bebenefi cial.
3 1 点赞
