季节性调整降压方案对原发性高血压患者心血管事件的影响

Effect of the seasonally adjusted antihypertensive regimen on cardiovascular events in patients with essential hypertension

目的探讨季节性调整降压药物治疗方案对原发性高血压患者主要心血管事件的影响。方法采用回顾性队列研究方法,对2005年9月至2015年9月原发性高血压患者690例(均连续接受降压药物治疗至少3年)进行分析。根据患者入组前至少3年的临床实际降压治疗方案分为3组:调整方案组(182例,冬季增加降压药物剂量或增加降压药物品种,夏季减少降压药物剂量或减少降压药物品种,每年冬夏调整降压治疗维持时间合计至少2个月)、固定方案组(262例,固定1种治疗方案)和随机方案组(246例,临时增减降压药物剂量或品种)。主要复合终点事件包括新发或再发非致死性脑卒中、新发或再发非致死性心肌梗死和心血管病死亡。采用Kaplan-Meier方法比较3组之间生存曲线的差异,并用Cox比例风险模型分析季节性调整降压药物治疗方案对心血管事件发生风险的影响。结果调整方案组明显降低冬季诊室血压和血压变异性(均P<0.05)。3组总共发生主要复合终点事件148例,其中脑卒中123例,心肌梗死43例,心血管病死亡39例;调整方案组、固定方案组和随机方案组主要复合终点事件发生率分别为13.19%、22.52%和26.42%,差异有统计学意义(χ~2=11.16,P=0.004)。经Log-Rank检验表明,调整方案组无主要复合终点事件累计生存率高于固定方案组和随机方案组(P<0.001)。经Cox比例风险回归模型分析表明,与固定方案组相比较,调整方案组的主要复合终点的相对风险下降16%(HR=0.84,95%CI0.53~0.93,P=0.005),脑卒中的相对风险下降52%(RR=0.48,95%CI0.26~0.88,P=0.015)。结论季节性调整降压药物治疗方案能明显减少原发性高血压患者的主要心血管事件。

Objective To investigate the effect of the seasonally adjusted antihypertensive regimen on major cardio vascular events in patients with essential hypertension. Methods A total of 690 essential hypertensive patients, receiving continuous antihypertensive treatment for at least three years, were included in this retrospective study between September 2005 and September 2015. The patients were divided into three groups according to practical antihypertensive regimen for at least three years： the adjusted regimen group （ 182 cases, increasing doses or classes of antihypertensive drugs in winter, and reducing doses or classes of antihypertensive drugs in summer for at least two months each year）, the fixed regimen group （262 cases, a fixed antihypertensive strategy） and the random regimen group （246 cases, adjusting doses or classes of antihypertensive drugs temporarily）. The primary end point was a composite of new or recurrent nonfatal myocardial infarction, new or recurrent nonfatal stroke, and death from cardi- ovascular diseases. Kaplan-Meier method was used to estimate the differences in survival curves among the three groups. Cox proportional hazards model was used to analyze the effect of the seasonally adjusted antihypertensive regimen on the risk of cardiovascular events. Results Office blood pressure in winter and blood pressure variability were significantly reduced in the adjusted regimen group than those in the other two groups （all P〈0.05）. A total of 148 patients reached the primary composite end point, including 123 cases of stroke, 43 cases of myocardial infarc tion and 39 cases of death from cardiovascular diseases. The incidence rate of primary composite end point in the adjusted regimen group, the fixed regimen group and the random regimen group was 13.19%, 22.52% and 26.42%, respec tively, and there was a significant difference in the incidence rate among the three groups （χ^2= 11.16, P= 0. 004 ）. Log-Rank test showed that the cumulative survival rate without primary composite end point in the adjusted regimen group was significantly higher than that in the other two groups （P〈0. 001 ）. Cox proportional hazards model showed that compared with the fixed regimen group, the relative risk of primary composite end point was decreased by 16% （RR=0.84, 95% CI 0. 53-0.93, P=0. 005）, and the relative risk of stroke was decreased by 52% （RR= 0.48, 95% CI 0. 26-0.88, P=0. 015） in the adjusted regimen group. Conclusion The seasonally adjusted antihypertensive regimen could significantly reduce major cardiovascular events in patients with essential hypertension.