Abstract：
UNASSIGNED: Cuff blood pressure (BP) is recommended for guiding hypertension management. However, central BP has been proposed as a superior clinical measurement. This study aimed to determine whether controlling hypertension as measured by central BP was beneficial in reducing left ventricular mass index beyond control of standard cuff hypertension.
UNASSIGNED: This multicenter, open-label, blinded-end point trial was conducted in individuals treated for uncomplicated hypertension with controlled cuff BP (<140/90 mm Hg) but elevated central BP (≥0.5 SD above age- and sex-specific normal values). Participants were randomized to 24-months intervention with spironolactone 25 mg/day (n=148) or usual care control (n=153). The primary outcome was change in left ventricular mass index measured by cardiac MRI. Cuff and central BPs were measured by clinic, 7-day home and 24-hour ambulatory BPs.
UNASSIGNED: At 24-months, there was a greater reduction in left ventricular mass index (-3.2 [95% CI, -5.0 to -1.3] g/m2; P=0.001) with intervention compared with control. Cuff and central BPs were lowered by a similar magnitude across all BP measurement modes (eg, clinic cuff systolic BP, -6.16 [-9.60 to -2.72] mm Hg and clinic central systolic BP, -4.96 [-8.06 to -1.86] mm Hg; P≥0.48 all). Secondary analyses found that changes in left ventricular mass index correlated to changes in BP, with the magnitude of effect nearly identical for BP measured by cuff (eg, 24-hour systolic BP, β, 0.17 [0.02-0.31] g/m2) or centrally (24-hour systolic BP, β, 0.16 [0.01-0.32] g/m2).
UNASSIGNED: Among individuals with central hypertension, spironolactone had beneficial effects in reducing LV mass. Secondary analyses showed that changes in LV mass were equally well associated with lower measured standard cuff BP and central BP.
UNASSIGNED: URL: https://www.anzctr.org.au/; Unique identifier: ACTRN12613000053729.
UNASSIGNED: This multicenter, open-label, blinded-end point trial was conducted in individuals treated for uncomplicated hypertension with controlled cuff BP (<140/90 mm Hg) but elevated central BP (≥0.5 SD above age- and sex-specific normal values). Participants were randomized to 24-months intervention with spironolactone 25 mg/day (n=148) or usual care control (n=153). The primary outcome was change in left ventricular mass index measured by cardiac MRI. Cuff and central BPs were measured by clinic, 7-day home and 24-hour ambulatory BPs.
UNASSIGNED: At 24-months, there was a greater reduction in left ventricular mass index (-3.2 [95% CI, -5.0 to -1.3] g/m2; P=0.001) with intervention compared with control. Cuff and central BPs were lowered by a similar magnitude across all BP measurement modes (eg, clinic cuff systolic BP, -6.16 [-9.60 to -2.72] mm Hg and clinic central systolic BP, -4.96 [-8.06 to -1.86] mm Hg; P≥0.48 all). Secondary analyses found that changes in left ventricular mass index correlated to changes in BP, with the magnitude of effect nearly identical for BP measured by cuff (eg, 24-hour systolic BP, β, 0.17 [0.02-0.31] g/m2) or centrally (24-hour systolic BP, β, 0.16 [0.01-0.32] g/m2).
UNASSIGNED: Among individuals with central hypertension, spironolactone had beneficial effects in reducing LV mass. Secondary analyses showed that changes in LV mass were equally well associated with lower measured standard cuff BP and central BP.
UNASSIGNED: URL: https://www.anzctr.org.au/; Unique identifier: ACTRN12613000053729.
摘要：
■建议使用袖带血压（BP）指导高血压管理。然而,中心血压已被提出作为一个优越的临床测量。这项研究旨在确定通过中枢BP测量的控制高血压是否有利于降低左心室质量指数，使其超出标准袖带高血压的控制范围。
■这个多中心，开放标签，我们在接受无并发症高血压治疗的患者中进行了盲终点试验,患者的袖带血压得到控制(<140/90mmHg),但中枢血压升高(比年龄和性别特定正常值高≥0.5SD).参与者被随机分为24个月，接受螺内酯25mg/天（n=148）或常规治疗对照（n=153）。主要结果是心脏MRI测量的左心室质量指数的变化。袖口和中央BP通过临床测量，7天的家庭和24小时的门诊BP。
■在24个月时，与对照组相比,干预后左心室质量指数降低更多(-3.2[95%CI,-5.0~-1.3]g/m2;P=0.001).在所有BP测量模式下，袖口和中央BP均降低了相似的幅度（例如，临床袖带收缩压，-6.16[-9.60至-2.72]mmHg和临床中心收缩压，-4.96[-8.06至-1.86]mmHg;所有P≥0.48)。二次分析发现左心室质量指数的变化与血压的变化有关，对于袖带测量的血压，影响程度几乎相同(例如，24小时收缩压,β,0.17[0.02-0.31]g/m2）或中心（24小时收缩压，β,0.16[0.01-0.32]g/m2)。
■在患有中心性高血压的个体中，螺内酯在减少LV质量方面具有有益作用。二次分析表明，LV质量的变化与较低的标准袖带血压和中央血压相关。
■URL：https://www。anzctr.org.au/;唯一标识符：ACTRN12613000053729。
■这个多中心，开放标签，我们在接受无并发症高血压治疗的患者中进行了盲终点试验,患者的袖带血压得到控制(<140/90mmHg),但中枢血压升高(比年龄和性别特定正常值高≥0.5SD).参与者被随机分为24个月，接受螺内酯25mg/天（n=148）或常规治疗对照（n=153）。主要结果是心脏MRI测量的左心室质量指数的变化。袖口和中央BP通过临床测量，7天的家庭和24小时的门诊BP。
■在24个月时，与对照组相比,干预后左心室质量指数降低更多(-3.2[95%CI,-5.0~-1.3]g/m2;P=0.001).在所有BP测量模式下，袖口和中央BP均降低了相似的幅度（例如，临床袖带收缩压，-6.16[-9.60至-2.72]mmHg和临床中心收缩压，-4.96[-8.06至-1.86]mmHg;所有P≥0.48)。二次分析发现左心室质量指数的变化与血压的变化有关，对于袖带测量的血压，影响程度几乎相同(例如，24小时收缩压,β,0.17[0.02-0.31]g/m2）或中心（24小时收缩压，β,0.16[0.01-0.32]g/m2)。
■在患有中心性高血压的个体中，螺内酯在减少LV质量方面具有有益作用。二次分析表明，LV质量的变化与较低的标准袖带血压和中央血压相关。
■URL：https://www。anzctr.org.au/;唯一标识符：ACTRN12613000053729。
