Blood pressure lowering in isolated diastolic hypertension and cardiovascular risk: an individual patient data meta-analysis.

Methods

Data from 51 randomized controlled trials were pooled to compare BP-lowering effects in participants with and without isolated diastolic hypertension (IDH), defined as systolic BP < 130 mmHg and diastolic BP ≥ 80 mmHg.

从51项随机对照试验中收集的数据被汇总起来，比较了有和没有孤立性舒张压高血压（IDH）参与者的降压效果，IDH定义为收缩压<130毫米汞柱且舒张压≥80毫米汞柱。

Treatment effects were stratified across baseline diastolic BP categories (range < 60 to ≥90 mmHg) among individuals with baseline systolic BP < 130 mmHg.

在基线收缩压小于130 mmHg的个体中，治疗效果根据基线舒张压的不同范围（小于60至大于等于90 mmHg）进行了分层。

Fixed-effect one-stage individual participant data meta-analyses were used, and Cox proportional hazard models, stratified by trial, were applied to analyse the data.

使用了固定效应的一阶段个体患者数据荟萃分析，并应用了按试验分层的Cox比例风险模型来分析数据。

Results

Among 358 325 participants, 15 845 (4.4%) had IDH.

在358 325名参与者中，有15 845人（占4.4%）患有IDH。

At a median follow-up of 4.2 years, a 5 mmHg reduction in systolic BP reduced the risk of major cardiovascular events similarly in individuals with IDH [hazard ratio0.91; 95% confidence interval(CI) 0.82-1.01] and those without IDH (hazard ratio0.90; 95% CI 0.89-0.92; P for interaction = 1.00).

在中位随访4.2年时，收缩压降低5毫米汞柱在患有IDH的个体中（风险比0.91；95%置信区间0.82-1.01）和没有IDH的个体中（风险比0.90；95%置信区间0.89-0.92；交互作用P值=1.00）相似地降低了主要心血管事件的风险。

Analyses by baseline diastolic BP showed no evidence of heterogeneity in treatment effects among individuals with baseline systolic BP < 130 mmHg (P for interaction = .26).

按基线舒张压分析显示，在基线收缩压<130毫米汞柱的个体中，治疗效果没有异质性的证据（交互作用P值=0.26）。

Relative treatment effects were not statistically different by CVD history, age, prior medication use, and BP measurement methods.

相对治疗效果在心血管疾病史、年龄、既往用药史和血压测量方法方面没有统计学上的差异。

Conclusions

The study found no evidence to suggest that pharmacological BP-lowering therapy in individuals with IDH is less or more effective than in those without IDH.

该研究未发现证据表明，在具有IDH的个体中，药物降压治疗的效果比没有IDH的个体更差或更好。

Relative risk reductions also did not diminish in those with lower diastolic BP, down to <60 mmHg at baseline.

相对风险降低在那些基线时舒张压较低（<60 mmHg）的患者中也没有减少。

No meaningful differences across various clinical phenotypes were detected.

未检测到各种临床表型之间有意义的差异。