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首页> 外文期刊>Italian Journal of Medicine >Aggressive blood pressure reduction in patients at high vascular risk: is it dangerous?
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Aggressive blood pressure reduction in patients at high vascular risk: is it dangerous?

机译：具有高血管风险的患者大幅度降低血压：危险吗？

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Introduction The aim of this review was to summarize the current state of evidence regarding the optimal blood pressure goals in patients with high vascular risk. In particular, this review critically addresses the issue of the “J-curve” paradox – a hypothesis indicating that low treatment-induced blood pressure values are characterized by an increase, rather than a decrease, in the incidence of cardiovascular events. Materials and methods We reviewed evidence from studies published in peer-reviewed journals indexed in Medline, EMBASE and CINAHL that compared different BP goals. Results Post-hoc analyses of randomized trials specifically conducted to test the hypothesis of the “J-shaped curve” yielded conflicting results. However, trials directly comparing different blood pressure goals and meta-analyses showed that in-treatment blood pressure values below the usual goal of less than 140/90 mmHg improve outcomes in patients at increased vascular risk. Discussion The fear that an excessive reduction in blood pressure may be dangerous is inconsistent with the available data and probably conditioned by the adverse impact of other risk factors that may be more frequent in patients with low values of achieved blood pressure. The association between blood pressure reduction and cardiovascular risk seems to be linear and not J-shaped.
机译：引言这篇综述的目的是总结有关高血管风险患者最佳血压目标的证据。尤其是，该评论批判性地解决了“ J曲线”悖论的问题-一种假说，表明低治疗诱导的血压值的特征是心血管事件发生率的增加而不是减少。材料和方法我们回顾了在Medline，EMBASE和CINAHL索引的同行评审期刊上发表的研究的证据，这些研究比较了不同的BP目标。结果专为测试“ J形曲线”假设而进行的随机试验的事后分析得出了相互矛盾的结果。然而，直接比较不同血压目标和荟萃分析的试验表明，低于通常目标140/90 mmHg以下的治疗中血压值可改善血管风险增加的患者的预后。讨论担心血压过度降低可能会造成危险，这与现有数据不一致，并且可能受到其他风险因素的不利影响的影响，而其他风险因素对已达到血压值较低的患者而言可能更为频繁。血压降低与心血管风险之间的关联似乎呈线性关系，而不呈J形。

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