美国SPRINT研究团队研究了强化降压和标准降压与脑白质病变的关系。相关研究结果发表在2019年8月13日出版的《美国医学会杂志》上。
在这项随机临床试验的子研究中，449名高血压患者被随机分配至强化降压组（收缩压不超过120毫米汞柱）和标准降压组（收缩压不超过140毫米汞柱），中位干预3.4年后，所有患者均接受纵向脑磁共振成像（MRI），观察脑白质病变总体积和总脑容量的变化。强化降压组患者的平均脑白质病变体积从4.57立方厘米增加至5.49立方厘米，增加了0.92立方厘米；而标准降压组则从4.40立方厘米增加到5.85立方厘米，增加了1.45立方厘米。强化降压组患者的平均总脑容量从1134.5立方厘米降至1104.0立方厘米，减少了30.6立方厘米；而标准降压组则从1134.0立方厘米降至1107.1立方厘米，减少了26.9立方厘米。
在患有高血压的成人中，强化降压与标准降压相比，脑白质病变体积的增加更小，脑总容量减少更多，但差异很小。
据介绍，目前强化降压对大脑健康的影响尚不确定。
注：SPRINT是由美国国立卫生研究院资助的一项血压干预试验项目。
附：英文原文
Title: Association of Intensive vs Standard Blood Pressure Control With Cerebral White Matter Lesions
Author:The SPRINT MIND Investigators for the SPRINT Research Group
Issue&Volume: Vol 322 No.6
Abstract:
Importance The effect of intensive blood pressure lowering on brain health remains uncertain.
Objective To evaluate the association of intensive blood pressure treatment with cerebral white matter lesion and brain volumes.
Design, Setting, and Participants A substudy of a multicenter randomized clinical trial of hypertensive adults 50 years or older without a history of diabetes or stroke at 27 sites in the United States. Randomization began on November 8, 2010. The overall trial was stopped early because of benefit for its primary outcome (a composite of cardiovascular events) and all-cause mortality on August 20, 2015. Brain magnetic resonance imaging (MRI) was performed on a subset of participants at baseline (n = 670) and at 4 years of follow-up (n = 449); final follow-up date was July 1, 2016.
Interventions Participants were randomized to a systolic blood pressure (SBP) goal of either less than 120 mm Hg (intensive treatment, n = 355) or less than 140 mm Hg (standard treatment, n = 315).
Main Outcomes and Measures The primary outcome was change in total white matter lesion volume from baseline. Change in total brain volume was a secondary outcome.
Results Among 670 recruited patients who had baseline MRI (mean age, 67.3 [SD, 8.2] years; 40.4% women), 449 (67.0%) completed the follow-up MRI at a median of 3.97 years after randomization, after a median intervention period of 3.40 years. In the intensive treatment group, based on a robust linear mixed model, mean white matter lesion volume increased from 4.57 to 5.49 cm3 (difference, 0.92 cm3 [95% CI, 0.69 to 1.14]) vs an increase from 4.40 to 5.85 cm3 (difference, 1.45 cm3 [95% CI, 1.21 to 1.70]) in the standard treatment group (between-group difference in change, −0.54 cm3 [95% CI, −0.87 to −0.20]). Mean total brain volume decreased from 1134.5 to 1104.0 cm3 (difference, −30.6 cm3 [95% CI, −32.3 to −28.8]) in the intensive treatment group vs a decrease from 1134.0 to 1107.1 cm3 (difference, −26.9 cm3 [95% CI, 24.8 to 28.8]) in the standard treatment group (between-group difference in change, −3.7 cm3 [95% CI, −6.3 to −1.1]).
Conclusions and Relevance Among hypertensive adults, targeting an SBP of less than 120 mm Hg, compared with less than 140 mm Hg, was significantly associated with a smaller increase in cerebral white matter lesion volume and a greater decrease in total brain volume, although the differences were small.
DOI: 10.1001/jama.2019.10551
Source: https://jamanetwork.com/journals/jama/article-abstract/2747671
JAMA-Journal of The American Medical Association：《美国医学会杂志》，创刊于1883年。隶属于美国医学协会，最新IF：157.335
官方网址：https://jamanetwork.com/
投稿链接：http://manuscripts.jama.com/cgi-bin/main.plex
本期文章：《美国医学会杂志》：Vol 322 No 6
