关键词: 高血压, 高危心血管病患者, 降压治疗, 心血管事件, 预防效果

Abstract:

Objective To explore the clinical benefits of antihypertensive interventions to high-risk cardiovascular patients，thus providing evidence for clinical practice. Methods From January 2015 to December 2020，a total of 45 823 hypertension patients from Batan Town and its surrounding 5 towns and 2 fields who were treated in the Binhai County Second People's Hospital were selected. According to the timing of antihypertensive intervention，they were divided into the early antihypertensive group （standard antihypertensive treatment initiated within 3 months of diagnosis，n=22 938） and delayed antihypertensive group （standard antihypertensive treatment initiated 3 months later after diagnosis，n=22 885）. According to the target value of blood pressure reduction，patients were further divided into the intensive blood pressure reduction group （n=22 938） and conventional blood pressure reduction group （n=22 885）. All patients were treated with an individualized antihypertensive regimen of monotherapy or combined drug therapy. The blood pressure control compliance rate，the incidence of cardiovascular events （coronary atherosclerotic heart disease，stroke，heart failure，cardiovascular death） and the incidence of major adverse cardiovascular events were compared between the early antihypertensive group and the delayed antihypertensive group after interventions. Clinical benefits and safety in the intensive antihypertensive group and the conventional antihypertensive group were analyzed. Results The 1-year and 3-year blood pressure control rates in the early antihypertensive group were higher than those in the delayed antihypertensive group （P<0.05）. During the 3 years of follow-up，the incidence of cardiovascular events in the early antihypertensive group was 15.0%（3 440 cases），and the incidence of cardiovascular events in the delayed antihypertensive group was 25.0%（5 721 cases）. The incidence of cardiovascular events in the early antihypertensive group was lower than that in the delayed antihypertensive group （χ²=529.53，P<0.01）.Compared with the conventional antihypertensive group （target systolic blood pressure < 140 mmHg），the risk of major cardiovascular adverse events in the intensive antihypertensive group （target systolic blood pressure <130 mmHg） was significantly lower （P<0.01）. Compared with the delayed hypotension group，the risk of cardiovascular events was significantly lower in the early hypotension group （P<0.01）. Conclusion Early and intensive antihypertensive interventions for high-risk cardiovascular patients can reduce the risk of cardiovascular events.

Key words: hypertension, high-risk cardiovascular patients, antihypertensive treatment, cardiovascular events, prevention effect