Relationship Between Sarcopenia and Intensive Blood Pressure Control Efficacy and Safety: A Secondary Analysis of SPRINT.

IF 6.9 1区医学 Q1 PERIPHERAL VASCULAR DISEASE Hypertension Pub Date : 2024-08-01 Epub Date: 2024-06-17 DOI:10.1161/HYPERTENSIONAHA.124.23011

Saeid Mirzai, Ian Persits, Richard Kazibwe, Mohanad Gabani, Austin Seals, Matthew J Singleton, Rishi Rikhi, Parag A Chevli, Salvatore Carbone, W H Wilson Tang, Joseph Yeboah, Jeff D Williamson, Dalane W Kitzman, David M Herrington, Michael D Shapiro

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Abstract

Background: Sarcopenia and hypertension are independently associated with worse cardiovascular disease (CVD) risk and survival. While individuals with sarcopenia may benefit from intensive blood pressure (BP) control, the increased vulnerability of this population raises concerns for potential harm. This study aimed to evaluate clinical and safety outcomes with intensive (target <120 mm Hg) versus standard (<140 mm Hg) systolic BP targets in older hypertensive adults with sarcopenia compared with nonsarcopenic counterparts in the SPRINT (Systolic Blood Pressure Intervention Trial).

Methods: Sarcopenia was defined using surrogates of the lowest sex-stratified median of the sarcopenia index (serum creatinine/cystatin C×100) for muscle wasting and gait speed ≤0.8 m/s for muscle weakness. Outcomes included CVD events, all-cause mortality, and serious adverse events.

Results: Of 2571 SPRINT participants with sarcopenia index and gait speed data available (aged ≥75 years), 502 (19.5%) met the criteria for sarcopenia, which was associated with higher risks of CVD events (adjusted hazard ratio, 1.49 [95% CI, 1.15-1.94]; P=0.003) and all-cause mortality (adjusted hazard ratio, 1.46 [95% CI, 1.09-1.94]; P=0.010). In participants with sarcopenia, intensive (versus standard) BP control nearly halved the risk of CVD events (adjusted hazard ratio, 0.57 [95% CI, 0.36-0.88]; P=0.012) without increasing serious adverse events. Similar risk reduction was seen for all-cause mortality in participants with sarcopenia (adjusted hazard ratio, 0.66 [95% CI, 0.41-1.08]; P=0.102), but the effect was only significant in those without chronic kidney disease.

Conclusions: Older hypertensive adults with sarcopenia randomized to intensive BP control experienced a lower risk of CVD without increased adverse events compared with standard BP control.

Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT01206062.

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Sarcopenia 与强化血压控制有效性和安全性之间的关系：SPRINT 的二次分析。

背景：肌肉疏松症和高血压与心血管疾病（CVD）风险和存活率的降低密切相关。虽然肌肉疏松症患者可能会从强化血压（BP）控制中获益，但这一人群的脆弱性增加了对潜在危害的担忧。本研究旨在评估强化血压控制（目标方法）的临床和安全性结果：肌肉疏松症是用肌肉疏松指数（血清肌酐/血胱抑素 C×100）的最低性别分层中位数来定义的，肌无力是用步速≤0.8 m/s来定义的。结果包括心血管疾病事件、全因死亡率和严重不良事件：在2571名有肌少症指数和步速数据的SPRINT参与者（年龄≥75岁）中，502人（19.5%）符合肌少症标准，这与较高的心血管疾病事件风险（调整后危险比为1.49 [95% CI, 1.15-1.94]；P=0.003）和全因死亡率（调整后危险比为1.46 [95% CI, 1.09-1.94]；P=0.010）相关。在患有肌肉疏松症的参与者中，强化血压控制（与标准血压控制相比）可将心血管疾病事件的风险降低近一半（调整后危险比为 0.57 [95% CI, 0.36-0.88]; P=0.012），而不会增加严重不良事件。患有肌肉疏松症的参与者的全因死亡率风险也有类似的降低（调整后的危险比为 0.66 [95% CI, 0.41-1.08]；P=0.102），但只有在没有慢性肾病的参与者中效果才显著：结论：与标准血压控制相比，随机接受强化血压控制的患有肌肉疏松症的老年高血压患者发生心血管疾病的风险较低，但不良事件并未增加：URL: https://www.clinicaltrials.gov; 唯一标识符：NCT01206062。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Hypertension 医学-外周血管病

CiteScore

15.90

自引率

4.80%

发文量

1006

审稿时长

1 months

期刊介绍： Hypertension presents top-tier articles on high blood pressure in each monthly release. These articles delve into basic science, clinical treatment, and prevention of hypertension and associated cardiovascular, metabolic, and renal conditions. Renowned for their lasting significance, these papers contribute to advancing our understanding and management of hypertension-related issues.