Tight versus standard blood pressure control in patients with hypertension with and without cardiovascular disease.

An excessive blood pressure (BP) reduction might be dangerous in high-risk patients with cardiovascular disease. In the Studio Italiano Sugli Effetti CARDIOvascolari del Controllo della Pressione Arteriosa SIStolica (Cardio-Sis), 1111 nondiabetic patients with systolic BP ≥150 mm Hg were randomly assigned to a systolic BP target <140 mm Hg (standard control) or <130 mm Hg (tight control). We stratified patients by absence (n=895) or presence (n=216) of established cardiovascular disease at entry. Antihypertensive treatment was open-label and tailored to each patient's needs. After 2-year follow-up, the primary end point of the study, electrocardiographic left ventricular hypertrophy, occurred less frequently in the tight than in the standard control group in the patients without (10.8% versus 15.2%) and with (14.1% versus 23.5%) established cardiovascular disease (P for interaction=0.82). The main secondary end point, a composite of cardiovascular events and all-cause death, occurred less frequently in the tight than in the standard control group both in patients without (1.47 versus 3.68 patient-years; P=0.016) and with (7.87 versus 11.22 patient-years; P=0.049) previous cardiovascular disease. In a multivariable Cox model, allocation to tight BP control reduced the risk of cardiovascular events to a similar extent in patients with or without overt cardiovascular disease at randomization (P for interaction=0.43). In conclusion, an intensive treatment aimed to lower systolic BP<130 mm Hg reduced left ventricular hypertrophy and improved clinical outcomes to a similar extent in patients with hypertension and without established cardiovascular disease.

Tight versus standard blood pressure control in patients with hypertension with and without cardiovascular disease. / Reboldi G;Angeli F;de Simone G;Staessen JA;Verdecchia P;Cardio-Sis Investigators;Porcellati C; Fornari G; Sclavo MG; Scherillo M; Raucci D; Faggiano P; Porcu M; Pistis L; Vancheri F; Curcio M; Ieva M; Muscella A; Guerrieri M; Dembech C; Gulizia MM; Francese GM; Perticone F; Iemma G; Zanolini G; Pierdomenico SD; Mezzetti A; Benemio G; Gattobigio R; Sacchi N; Cocchieri M; Prosciutti L; Garognoli O; Pirelli S; Emanuelli C; Galeazzi G; Abrignani MG; Lombardo R; Braschi GB; Leoncini G; Igidbashian D; Marini R; Mandorla S; Buccolieri M; Picchi L; Casolo G; Pardini M; Galletti F; Barbato A; Cavallini C; Borgioni C; Sardone MG; Cipollini F; Seghieri G; Arcangeli E; Boddi W; Palermo C; Lembo G; Malatino L; Leonardis D; Gentile C; Boccanelli A; Mureddu GF; Colivicchi F; Uguccioni M; Zanata G; Martin G; Mos L; Martina S; Dialti V; Pede S; Pede SA; Ganau A; Farina G; Tripodi E; Miserrafiti B; Stornello M; Valvo EV; Proietti G; Bernardinangeli M; Poddighe G; Marras MA; Biscottini B; Panciarola R; Veglio F; Mulatero P; Caserta MA; Chiatto M; Cioffi G; Bonazza G; Achilli A; Achilli P.. - In: HYPERTENSION. - ISSN 0194-911X. - STAMPA. - 63:3(2014), pp. 475-482.



Titolo: Tight versus standard blood pressure control in patients with hypertension with and without cardiovascular disease.
Autori Riconosciuti: 
VEGLIO, Franco  
MULATERO, Paolo  
mostra contributor esterni 
Autori: Reboldi G;Angeli F;de Simone G;Staessen JA;Verdecchia P;Cardio-Sis Investigators;Porcellati C; Fornari G; Sclavo MG; Scherillo M; Raucci D; Faggiano P; Porcu M; Pistis L; Vancheri F; Curcio M; Ieva M; Muscella A; Guerrieri M; Dembech C; Gulizia MM; Francese GM; Perticone F; Iemma G; Zanolini G; Pierdomenico SD; Mezzetti A; Benemio G; Gattobigio R; Sacchi N; Cocchieri M; Prosciutti L; Garognoli O; Pirelli S; Emanuelli C; Galeazzi G; Abrignani MG; Lombardo R; Braschi GB; Leoncini G; Igidbashian D; Marini R; Mandorla S; Buccolieri M; Picchi L; Casolo G; Pardini M; Galletti F; Barbato A; Cavallini C; Borgioni C; Sardone MG; Cipollini F; Seghieri G; Arcangeli E; Boddi W; Palermo C; Lembo G; Malatino L; Leonardis D; Gentile C; Boccanelli A; Mureddu GF; Colivicchi F; Uguccioni M; Zanata G; Martin G; Mos L; Martina S; Dialti V; Pede S; Pede SA; Ganau A; Farina G; Tripodi E; Miserrafiti B; Stornello M; Valvo EV; Proietti G; Bernardinangeli M; Poddighe G; Marras MA; Biscottini B; Panciarola R; Veglio F; Mulatero P; Caserta MA; Chiatto M; Cioffi G; Bonazza G; Achilli A; Achilli P.
Data di pubblicazione: 2014
Abstract: An excessive blood pressure (BP) reduction might be dangerous in high-risk patients with cardiovascular disease. In the Studio Italiano Sugli Effetti CARDIOvascolari del Controllo della Pressione Arteriosa SIStolica (Cardio-Sis), 1111 nondiabetic patients with systolic BP ≥150 mm Hg were randomly assigned to a systolic BP target <140 mm Hg (standard control) or <130 mm Hg (tight control). We stratified patients by absence (n=895) or presence (n=216) of established cardiovascular disease at entry. Antihypertensive treatment was open-label and tailored to each patient's needs. After 2-year follow-up, the primary end point of the study, electrocardiographic left ventricular hypertrophy, occurred less frequently in the tight than in the standard control group in the patients without (10.8% versus 15.2%) and with (14.1% versus 23.5%) established cardiovascular disease (P for interaction=0.82). The main secondary end point, a composite of cardiovascular events and all-cause death, occurred less frequently in the tight than in the standard control group both in patients without (1.47 versus 3.68 patient-years; P=0.016) and with (7.87 versus 11.22 patient-years; P=0.049) previous cardiovascular disease. In a multivariable Cox model, allocation to tight BP control reduced the risk of cardiovascular events to a similar extent in patients with or without overt cardiovascular disease at randomization (P for interaction=0.43). In conclusion, an intensive treatment aimed to lower systolic BP<130 mm Hg reduced left ventricular hypertrophy and improved clinical outcomes to a similar extent in patients with hypertension and without established cardiovascular disease.
Volume: 63
Fascicolo: 3
Pagina iniziale: 475
Pagina finale: 482
Digital Object Identifier (DOI): 10.1161/HYPERTENSIONAHA.113.02089
Parole Chiave: systolic blood pressure; hypertension
Rivista: HYPERTENSION
Appare nelle tipologie:03A-Articolo su Rivista

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