Heart Stress and Blood Pressure Management in Older Adults: Post Hoc Analysis of the ASPREE Trial.

Heart stress (HS), defined by age-adjusted elevation in NT-proBNP (N-terminal pro-B-type natriuretic peptide) levels, may improve cardiovascular disease (CVD) risk stratification and support more individualized BP management.

通过年龄调整的NT-proBNP（N末端前体B型利钠肽）水平升高定义的心脏应激(HS)，可能改善心血管疾病(CVD)风险分层，并支持更加个性化的血压管理。

Methods

We conducted a post hoc analysis of ASPREE (Aspirin in Reducing Events in the Elderly) involving 11 941 community-dwelling older adults without CVD at enrollment (mean age, 75.1 years; 53.5% women).

我们对ASPREE（老年人减少事件的阿司匹林）进行了事后分析，涉及11,941名在入组时没有心血管疾病的社区居住老年人（平均年龄75.1岁；53.5%为女性）。

HS was defined by NT-proBNP ≥150 pg/mL for participants 65 to 74 years of age and ≥300 pg/mL for participants ≥75 years of age.

心力衰竭（HS）的定义是：对于65至74岁的参与者，NT-proBNP≥150 pg/mL；对于≥75岁的参与者，NT-proBNP≥300 pg/mL。

Participants were categorized into 4 groups by hypertension and HS status.

参与者根据高血压和高盐状态被分为4组。

The primary outcome was total CVD events (a composite of nonfatal myocardial infarction, fatal or nonfatal stroke, coronary heart disease death, or hospitalization for heart failure).

主要结果是总的心血管疾病事件（包括非致命性心肌梗死、致命或非致命性中风、冠心病死亡或因心力衰竭住院的复合结果）。

Associations between hypertension and SBP with total CVD events were examined by HS status using Cox proportional-hazards models and restricted cubic spline.

通过使用Cox比例风险模型和限制性立方样条，研究了高血压和收缩压（SBP）与总心血管疾病（CVD）事件之间的关联，根据健康状况（HS）进行分类。

SBP was evaluated categorically (<120, 120-129, 130-139, 140-159, or ≥160 mm Hg) and continuously.

SBP被分类评估（<120, 120-129, 130-139, 140-159, 或 ≥160 mm Hg）和连续评估。

A landmark sensitivity analysis excluded participants with CVD events or censoring in the first 2 years, with follow-up starting at year 3.

一项里程碑式的敏感性分析排除了在前两年内发生心血管疾病事件或被删失的参与者，随访从第三年开始。

Results

HS was present in 25.8% of participants.

25.8%的参与者存在HS。

Compared with the reference group (no hypertension or HS), adjusted hazard ratios (95% CI) for total CVD events were 1.41 (1.18-1.70) for hypertension + no HS, 1.79 (1.34-2.39) for no hypertension + HS, and 2.32 (1.89-2.84) for hypertension + HS (Ptrend<0.001).

与参考组（无高血压或高敏C反应蛋白）相比，调整后的危险比（95%置信区间）对于总心血管疾病（CVD）事件为：仅高血压1.41（1.18-1.70），仅高敏C反应蛋白1.79（1.34-2.39），高血压合并高敏C反应蛋白2.32（1.89-2.84）（趋势检验P<0.001）。

Among participants without HS, the lowest incidenceof total CVD events occurred at SBP 130 to 139 mm Hg, showing a U-shaped association across SBP levels (Pnonlinearity=0.011).

在没有高敏C反应蛋白的参与者中，总心血管疾病（CVD）事件的最低发生率出现在收缩压（SBP）为130至139毫米汞柱时，显示出收缩压水平的U型关联（非线性检验P=0.011）。

Among participants with HS, risk increased linearly with SBP (Plinear trend=0.85) and was lowest at SBP <120 mm Hg.

在患有HS的参与者中，风险随着收缩压（SBP）的增加而线性增加（P线性趋势=0.85），在SBP <120毫米汞柱时风险最低。

Landmark analyses yielded generally consistent findings.

里程碑分析得出了一致的发现。

Conclusions

HS is common in older adults and jointly associated with hypertension and increased CVD risk.

HS在老年成人中很常见，与高血压和增加的心血管疾病(CVD)风险共同相关。

The SBP-CVD relationship differs by HS status, suggesting a potential value of HS for guiding individualized BP management.

SBP与CVD的关系因HS状态而异，这表明HS对于指导个体化血压管理具有潜在价值。

Prospective studies are warranted to determine whether HS-guided strategies improve BP control and reduce CVD risk in older adults.

有必要进行前瞻性研究以确定HS指导策略是否能改善老年患者的血压控制并降低心血管疾病风险。