Abstract：
UNASSIGNED: Systolic blood pressure (BP) is a key predictor of cardiovascular events, but patients with peripheral artery disease (PAD) are rarely included in hypertension trials. The VALUE trial (Valsartan Antihypertensive Long-Term Use Evaluation) investigated the long-term effects of valsartan- or amlodipine-based treatments on cardiovascular outcomes in patients with hypertension with a high cardiovascular risk. The aim of this subanalysis was to clarify the relationship between achieved BP on treatment and cardiovascular outcomes in patients with hypertension with PAD.
UNASSIGNED: Patients were followed for 4 to 6 years, and BP was measured regularly. The primary end point was time to the first major adverse cardiovascular event, including myocardial infarction, stroke, cardiovascular death, and heart failure requiring hospitalization. Statistical analyses were performed using Cox regression, adjusting for various baseline covariates.
UNASSIGNED: Of the 13 803 participants, 1898 (13.8%) had PAD. During a median follow-up of 4.5 years, patients with PAD had a 23% increased risk of major adverse cardiovascular events compared with patients without PAD. Patients with an achieved systolic BP <130 mm Hg and 130 to 139 mm Hg, compared with those with systolic BP ≥140 mm Hg, were associated with a decreased risk of a major adverse cardiovascular event (hazard ratio, 0.65 [95% CI, 0.43-0.97]; P=0.037; 0.85 [95% CI, 0.74-0.97]; P=0.016, respectively). Additionally, systolic BP <130 mm Hg was associated with a decreased risk of cardiovascular death (hazard ratio, 0.33 [95% CI, 0.12-0.92]; P=0.034). The incidence of the primary outcome did not differ between antihypertensive treatment regimens (P=0.365).
UNASSIGNED: Our results indicate that more intensive BP control is associated with a reduction in cardiovascular morbidity and mortality in patients with hypertensive PAD.
UNASSIGNED: Patients were followed for 4 to 6 years, and BP was measured regularly. The primary end point was time to the first major adverse cardiovascular event, including myocardial infarction, stroke, cardiovascular death, and heart failure requiring hospitalization. Statistical analyses were performed using Cox regression, adjusting for various baseline covariates.
UNASSIGNED: Of the 13 803 participants, 1898 (13.8%) had PAD. During a median follow-up of 4.5 years, patients with PAD had a 23% increased risk of major adverse cardiovascular events compared with patients without PAD. Patients with an achieved systolic BP <130 mm Hg and 130 to 139 mm Hg, compared with those with systolic BP ≥140 mm Hg, were associated with a decreased risk of a major adverse cardiovascular event (hazard ratio, 0.65 [95% CI, 0.43-0.97]; P=0.037; 0.85 [95% CI, 0.74-0.97]; P=0.016, respectively). Additionally, systolic BP <130 mm Hg was associated with a decreased risk of cardiovascular death (hazard ratio, 0.33 [95% CI, 0.12-0.92]; P=0.034). The incidence of the primary outcome did not differ between antihypertensive treatment regimens (P=0.365).
UNASSIGNED: Our results indicate that more intensive BP control is associated with a reduction in cardiovascular morbidity and mortality in patients with hypertensive PAD.
摘要：
收缩压（BP）是心血管事件的关键预测因子，但外周动脉疾病(PAD)患者很少纳入高血压试验.VALUE试验（缬沙坦抗高血压长期使用评估）研究了基于缬沙坦或氨氯地平的治疗对高心血管风险高血压患者心血管结局的长期影响。此子分析的目的是阐明高血压合并PAD患者在治疗时达到的BP与心血管结局之间的关系。
■患者随访4至6年，并定期测量血压。主要终点是首次主要不良心血管事件发生的时间,包括心肌梗塞,中风,心血管死亡,心力衰竭需要住院治疗.使用Cox回归进行统计分析，调整各种基线协变量。
■在13803名参与者中，1898（13.8%）患有PAD。在4.5年的中位随访期间，与无PAD的患者相比,有PAD的患者发生主要不良心血管事件的风险增加23%.收缩压<130mmHg和130至139mmHg的患者，与收缩压≥140mmHg的患者相比，与主要不良心血管事件的风险降低相关(风险比，0.65[95%CI,0.43-0.97];P=0.037;0.85[95%CI,0.74-0.97];P=0.016)。此外,收缩压<130mmHg与心血管死亡风险降低相关(风险比，0.33[95%CI，0.12-0.92]；P=0.034）。不同降压治疗方案的主要结局发生率无差异(P=0.365)。
■我们的结果表明，更密集的BP控制与高血压PAD患者心血管发病率和死亡率的降低有关。
■患者随访4至6年，并定期测量血压。主要终点是首次主要不良心血管事件发生的时间,包括心肌梗塞,中风,心血管死亡,心力衰竭需要住院治疗.使用Cox回归进行统计分析，调整各种基线协变量。
■在13803名参与者中，1898（13.8%）患有PAD。在4.5年的中位随访期间，与无PAD的患者相比,有PAD的患者发生主要不良心血管事件的风险增加23%.收缩压<130mmHg和130至139mmHg的患者，与收缩压≥140mmHg的患者相比，与主要不良心血管事件的风险降低相关(风险比，0.65[95%CI,0.43-0.97];P=0.037;0.85[95%CI,0.74-0.97];P=0.016)。此外,收缩压<130mmHg与心血管死亡风险降低相关(风险比，0.33[95%CI，0.12-0.92]；P=0.034）。不同降压治疗方案的主要结局发生率无差异(P=0.365)。
■我们的结果表明，更密集的BP控制与高血压PAD患者心血管发病率和死亡率的降低有关。
