Effects of Intensive Blood Pressure Lowering on Cardiovascular and Renal Outcomes A Systematic Review and Meta-Analysis 英文参考文献.docVIP

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2017-05-11 发布于上海
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Effects of Intensive Blood Pressure Lowering on Cardiovascular and Renal Outcomes A Systematic Review and Meta-Analysis 英文参考文献.doc

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Effects of Intensive Blood Pressure Lowering on Cardiovascular and Renal Outcomes A Systematic Review and Meta-Analysis 英文参考文献

EffectsofIntensiveBloodPressureLoweringon CardiovascularandRenalOutcomes:ASystematic ReviewandMeta-Analysis JichengLv1,2,BruceNeal1,ParyaEhteshami1,ToshiharuNinomiya4,MarkWoodward1,3, AnthonyRodgers1,HaiyanWang2,StephenMacMahon1,FionaTurnbull1,GrahamHillis1, JohnChalmers1,VladoPerkovic1* 1TheGeorgeInstituteforGlobalHealth,TheUniversityofSydney,Sydney,Australia,2RenalDivision,DepartmentofMedicine,PekingUniversityFirstHospital,Beijing, China,3DepartmentofEpidemiology,JohnsHopkinsUniversity,Baltimore,Maryland,UnitedStatesofAmerica,4DepartmentofMedicineandClinicalScienceGraduate SchoolofMedicalSciences,KyushuUniversity,Japan Abstract Background: Guidelines recommend intensive blood pressure (BP) lowering in patients at high risk. While placebo- controlledtrialshavedemonstrated22%reductionsincoronaryheartdisease(CHD)andstrokeassociatedwitha10-mmHg differenceinsystolicBP,itisunclearifmoreintensiveBPloweringstrategiesareassociatedwithgreaterreductionsinriskof CHD and stroke. We did a systematic review to assess the effects of intensive BP lowering on vascular, eye, and renal outcomes. Methods and Findings: We systematically searched Medline, Embase, and the Cochrane Library for trials published We between 1950 and July 2011. We included trials that randomly assigned individuals to different target BP levels. identified15trialsincludingatotalof37,348participants.Onaveragetherewasa7.5/4.5-mmHgBPdifference.IntensiveBP loweringachievedrelativerisk(RR)reductionsof11%formajorcardiovascularevents(95%CI1%–21%),13%formyocardial infarction (0%–25%), 24% for stroke (8%–37%), and 11% for end stage kidney disease (3%–18%). Intensive BP lowering regimensalsoproduceda10%reductionintheriskofalbuminuria(4%–16%),andatrendtowardsbenefitforretinopathy (19%,0%–34%,p=0.051)inpatientswithdiabetes.Therewasnocleareffectoncardiovascularornoncardiovasculardeath. IntensiveBPloweringwaswelltolerated;withseriousadverseeventsuncommonandnotsignificantlyincreased,exceptfor hypotension(RR4.16,95%CI2.25to7.