Intensive Blood Pressure Strategy on Cardiovascular Diseases in Patients With Metabolic Syndrome: Post Hoc Analysis of a Clinical Trial.

IF 5 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of the American Heart Association Pub Date : 2025-03-18 Epub Date: 2025-03-13 DOI:10.1161/JAHA.124.036820

Guozhe Sun, Xiaofan Guo, Guangxiao Li, Pengyu Zhang, Yangzhi Yin, Lixia Qiao, Ning Ye, Chang Wang, Songyue Liu, Danxi Geng, Wei Miao, Ziyi Xie, Yao Yu, Zhi Li, Xiaoqiong Jiang, Xiangyu Tan, Yingxian Sun

{"title":"Intensive Blood Pressure Strategy on Cardiovascular Diseases in Patients With Metabolic Syndrome: Post Hoc Analysis of a Clinical Trial.","authors":"Guozhe Sun, Xiaofan Guo, Guangxiao Li, Pengyu Zhang, Yangzhi Yin, Lixia Qiao, Ning Ye, Chang Wang, Songyue Liu, Danxi Geng, Wei Miao, Ziyi Xie, Yao Yu, Zhi Li, Xiaoqiong Jiang, Xiangyu Tan, Yingxian Sun","doi":"10.1161/JAHA.124.036820","DOIUrl":null,"url":null,"abstract":"Background: Blood pressure (BP) management in patients with metabolic syndrome is complex, and optimal targets remain debated. The CRHCP (China Rural Hypertension Control Project) trial demonstrated that intensive BP control reduces cardiovascular events. This secondary analysis assessed its efficacy in patients with hypertension and metabolic syndrome.Methods and results: This a post hoc analysis of a cluster randomized trial (NCT03527719) across 3 Chinese provinces; 18 076 hypertensive patients with metabolic syndrome were followed up for 3 years. Intervention groups received multifaceted BP management by nonphysician health care professionals aiming for <130/80 mm Hg BP under physician supervision. The primary outcome of major adverse cardiovascular events included stroke, myocardial infarction, heart failure, and death from cardiovascular causes, during a 3-year follow-up. A total of 18 076 participants (median [range] age, 63 [54-72] years; 13 056 [72.2%] women) were enrolled in 2 clusters and were adjudicated for the primary outcome (control, 9337; intervention, 8739). At the end of the 3-year follow-up, the mean systolic/diastolic BP was 126.3/73.0 mm Hg in the intervention group versus 147.3/82.0 mm Hg in the usual care group. Compared with the usual care group, the intervention group had a lower rate of major adverse cardiovascular events (1.58% versus 2.42% per year; hazard ratio [HR], 0.65 [95% CI, 0.57-0.74]; P<0.001), as well as stroke (HR, 0.68 [95% CI, 0.55-0.83]; P=0.015), myocardial infarction (HR, 0.70 [95% CI, 0.51-0.97]; P=0.034), death from cardiovascular causes (HR, 0.67 [95% CI, 0.47-0.96]; P=0.029), and death from all causes (HR, 0.82 [95% CI, 0.71-0.94]; P=0.005).Conclusions: Intensive BP control (<130/80 mm Hg) by trained nonphysician community health care professionals effectively reduces cardiovascular events in patients with hypertension and metabolic syndrome.Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03527719.","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e036820"},"PeriodicalIF":5.0000,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of the American Heart Association","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1161/JAHA.124.036820","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/3/13 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}

引用次数: 0

Abstract

Background: Blood pressure (BP) management in patients with metabolic syndrome is complex, and optimal targets remain debated. The CRHCP (China Rural Hypertension Control Project) trial demonstrated that intensive BP control reduces cardiovascular events. This secondary analysis assessed its efficacy in patients with hypertension and metabolic syndrome.

Methods and results: This a post hoc analysis of a cluster randomized trial (NCT03527719) across 3 Chinese provinces; 18 076 hypertensive patients with metabolic syndrome were followed up for 3 years. Intervention groups received multifaceted BP management by nonphysician health care professionals aiming for <130/80 mm Hg BP under physician supervision. The primary outcome of major adverse cardiovascular events included stroke, myocardial infarction, heart failure, and death from cardiovascular causes, during a 3-year follow-up. A total of 18 076 participants (median [range] age, 63 [54-72] years; 13 056 [72.2%] women) were enrolled in 2 clusters and were adjudicated for the primary outcome (control, 9337; intervention, 8739). At the end of the 3-year follow-up, the mean systolic/diastolic BP was 126.3/73.0 mm Hg in the intervention group versus 147.3/82.0 mm Hg in the usual care group. Compared with the usual care group, the intervention group had a lower rate of major adverse cardiovascular events (1.58% versus 2.42% per year; hazard ratio [HR], 0.65 [95% CI, 0.57-0.74]; P<0.001), as well as stroke (HR, 0.68 [95% CI, 0.55-0.83]; P=0.015), myocardial infarction (HR, 0.70 [95% CI, 0.51-0.97]; P=0.034), death from cardiovascular causes (HR, 0.67 [95% CI, 0.47-0.96]; P=0.029), and death from all causes (HR, 0.82 [95% CI, 0.71-0.94]; P=0.005).

Conclusions: Intensive BP control (<130/80 mm Hg) by trained nonphysician community health care professionals effectively reduces cardiovascular events in patients with hypertension and metabolic syndrome.

Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03527719.

查看原文本刊更多论文

代谢综合征患者心血管疾病的强化血压策略：一项临床试验的事后分析

背景：代谢综合征患者的血压（BP）管理是复杂的，最佳目标仍然存在争议。CRHCP（中国农村高血压控制项目）试验表明，强化血压控制可减少心血管事件。这项二级分析评估了其对高血压和代谢综合征患者的疗效。方法和结果：这是一项针对中国3个省份的聚类随机试验（NCT03527719）的事后分析；对18076例合并代谢综合征的高血压患者进行了为期3年的随访。干预组接受非医师卫生保健专业人员的全方位血压管理，目标是血压=0.015)、心肌梗死(HR, 0.70 [95% CI, 0.51-0.97]；P=0.034)，心血管原因死亡(HR, 0.67 [95% CI, 0.47-0.96]；P=0.029)和全因死亡(HR, 0.82 [95% CI, 0.71-0.94]；P = 0.005)。结论：强化血压控制(注册网址：https://www.clinicaltrials.gov；唯一标识符：NCT03527719。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Journal of the American Heart Association CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

9.40

自引率

1.90%

发文量

1749

审稿时长

12 weeks

期刊介绍： As an Open Access journal, JAHA - Journal of the American Heart Association is rapidly and freely available, accelerating the translation of strong science into effective practice. JAHA is an authoritative, peer-reviewed Open Access journal focusing on cardiovascular and cerebrovascular disease. JAHA provides a global forum for basic and clinical research and timely reviews on cardiovascular disease and stroke. As an Open Access journal, its content is free on publication to read, download, and share, accelerating the translation of strong science into effective practice.