Sex-Specific Association between Systolic Blood Pressure Time in Target Range and Cardiovascular Outcomes: A Post-Hoc Analysis of the SPRINT Trial.

IF 1.9 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Reviews in cardiovascular medicine Pub Date : 2025-03-18 eCollection Date: 2025-03-01 DOI:10.31083/RCM26262

Yuekun Zhang, Wen Zheng, Chao Jiang, Wen Hao, Wei Gong, Yan Yan, Xiao Wang, Changsheng Ma, Shaoping Nie

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引用次数: 0

Abstract

Background: Systolic blood pressure time in target range (SBP TTR) is a novel metric for blood pressure control. Previous studies have demonstrated an inverse association between SBP TTR and risks of cardiovascular events, but sex differences have never been reported. This study aims to investigate the sex-specific differences in the relationship using data from the Systolic Blood Pressure Intervention Trial (SPRINT).

Methods: This post hoc analysis included 8822 SPRINT participants with at least three follow-up systolic blood pressure (SBP) measurements within the first three months. SBP TTR was calculated using the Rosendaal method of linear interpolation. The primary endpoint was major adverse cardiovascular and cerebrovascular events (MACCE). Cox proportional hazards models and restricted cubic splines (RCS) were used to assess the association between SBP TTR and cardiovascular events.

Results: Women accounted for 35.3% with a mean age of 68.6 ± 9.5 years, having a higher body mass index (p = 0.007) and a lower SBP TTR compared to men (p < 0.001). In the overall population and in women, each standard deviation (SD) increase in SBP TTR was associated with a reduced risk of MACCE (adjusted hazard ratio (HR) 0.89; 95% confidence interval (CI) 0.82-0.97; p = 0.007, and adjusted HR 0.85; 95% CI 0.74-0.99; p = 0.039, respectively) and acute decompensated heart failure (adjusted HR 0.86; 95% CI 0.73-0.99; p = 0.047, and adjusted HR 0.68; 95% CI 0.51-0.92; p = 0.011, respectively), while this was not observed in men. RCS indicated a similar trend in men only when SBP TTR exceeded 39%. Additional adjustments for mean SBP and SBP variability yielded similar outcomes.

Conclusions: The study demonstrates that in women, a higher SBP TTR is associated with a reduced risk of MACCE and acute decompensated heart failure, while in men, a similar trend is observed only when SBP TTR is higher, underscoring the necessity of considering sex differences in personalized blood pressure management strategies.

Clinical trial registration: NCT01206062, https://www.clinicaltrials.gov/expert-search?term=NCT01206062.

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背景：收缩压在目标范围内的时间（SBP TTR）是血压控制的一个新指标。以往的研究表明，收缩压在目标范围内的时间与心血管事件的风险呈负相关，但从未报道过性别差异。本研究旨在利用收缩压干预试验（SPRINT）的数据，研究两者之间的性别差异：这项事后分析包括 8822 名 SPRINT 参与者，他们在头三个月内至少进行了三次随访收缩压（SBP）测量。采用Rosendaal线性插值法计算SBP TTR。主要终点是主要心脑血管不良事件（MACCE）。采用 Cox 比例危险模型和限制性立方样条（RCS）评估 SBP TTR 与心血管事件之间的关系：女性占 35.3%，平均年龄为 68.6 ± 9.5 岁，与男性相比，女性的体重指数更高（p = 0.007），SBP TTR 更低（p < 0.001）。在总体人群和女性中，SBP TTR 每增加一个标准差 (SD) 都与 MACCE 风险降低有关（调整后危险比 (HR) 0.89; 95% 置信区间 (CI) 0.82-0.97; p = 0.007，调整后 HR 0.85；95% CI 0.74-0.99；p = 0.039）和急性失代偿性心力衰竭（调整后的HR分别为0.86；95% CI 0.73-0.99；p = 0.047，调整后的HR分别为0.68；95% CI 0.51-0.92；p = 0.011），而在男性中未观察到这种情况。只有当 SBP TTR 超过 39% 时，男性的 RCS 才显示出类似的趋势。对平均 SBP 和 SBP 变异性的额外调整也产生了相似的结果：该研究表明，女性 SBP TTR 越高，MACCE 和急性失代偿性心力衰竭的风险越低，而男性只有在 SBP TTR 越高时才会出现类似趋势，这强调了在个性化血压管理策略中考虑性别差异的必要性：临床试验注册：NCT01206062，https://www.clinicaltrials.gov/expert-search?term=NCT01206062。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Reviews in cardiovascular medicine 医学-心血管系统

CiteScore

2.70

自引率

3.70%

发文量

377

审稿时长

1 months

期刊介绍： RCM is an international, peer-reviewed, open access journal. RCM publishes research articles, review papers and short communications on cardiovascular medicine as well as research on cardiovascular disease. We aim to provide a forum for publishing papers which explore the pathogenesis and promote the progression of cardiac and vascular diseases. We also seek to establish an interdisciplinary platform, focusing on translational issues, to facilitate the advancement of research, clinical treatment and diagnostic procedures. Heart surgery, cardiovascular imaging, risk factors and various clinical cardiac & vascular research will be considered.