摘要
【ABSTRACT】【Background】The optimal blood pressure (BP) target for older adults with hypertension remains controversial, particularly among those with advanced age, frailty, or polypharmacy. This study estimated the individualized net benefit of intensive BP lowering among community‐dwelling older adults in the Systolic Blood Pressure Intervention Trial (SPRINT).【Methods】Among 5143 SPRINT participants age ≥ 65 years, Cox models were internally validated to predict an absolute difference in risk between treating to a systolic BP target of < 120 versus < 140 mm Hg for all‐cause death, cardiovascular outcomes, cognitive outcomes, and serious adverse events. Treatment effects were combined using simulated preference weights into individualized net benefits, representing the weighted sum of risk differences across outcomes. Net benefits were compared across categories of age (65–74 vs. ≥ 75 years), SPRINT‐derived frailty status (fit, less fit, and frail), and polypharmacy (≥ 5 medications).【Results】When simulating preferences for participants who view the benefits of BP lowering (reduction in death, cardiovascular events, and cognitive impairment) as much more important than treatment‐related harms (e.g., acute kidney injury and syncope), the median net benefit from intensive BP lowering was 4 percentage points (IQR: 3–6), and 100% had a positive net benefit favoring intensive BP lowering. When simulating benefits and harms to have similar, intermediate importance, the median net benefit was 1 percentage point (IQR: 0–2), and 85% had a positive net benefit. Participants with advanced age and frailty had greater net benefits from intensive BP lowering despite experiencing more harm in both simulations, and those with polypharmacy had greater net benefits when benefits were viewed as much more important than harms (p < 0.001 for all comparisons).【Conclusions】Among community‐dwelling older adults with hypertension in SPRINT, almost all participants had a net benefit that favored a systolic BP target of < 120 mm Hg, but the magnitude of net benefit varied according to estimated risks and simulated preferences.
摘要译文
【摘要】【背景】高血压老年人的最佳血压（BP）靶标仍然有争议，尤其是在年龄，脆弱或多药的人中。这项研究估计了收缩压干预试验（SPRINT）（SPRINT）中居住在社区居住的老年人中降低强化BP的个性化净益处。在5143 Sprint参与者≥65岁的Sprint参与者中，COX模型在内部进行了验证，以预测为Altermant varge of Alter targe at a Antrovely BP的绝对差异，该目标远处是<120 versus <120 versus <140 vers y 140 vers y 140 vers y 140mmMH，ccc cy y140 cc ccc y 140mm hg cc ccc cy y 140 cc cc cy y 140 cc cc cy y140mm m hg cc。认知结果和严重的不利事件。使用模拟优先权重与个性化的净福利结合了治疗效果，代表了跨结果的加权风险差异。比较了年龄段（65-74岁与≥75岁），Sprint衍生的脆弱状态（合身，较差和脆弱）和多药（≥5药物）的净收益。【结果】在模拟偏好的偏好时，对BP降低的益处（降低了死亡，心脏病性事件的损害）时，比较重要的是（EL）相比，相当于造成损害的损害和cognaliage nigrime Impair and Impair and Impair and Impair and Impair and Impair and Impair（非常重要）（非常重要）急性肾脏损伤和晕厥），降低BP的中位净收益为4个百分点（IQR：3-6），而100％的净收益为阳性，有利于强化BP降低。当模拟具有相似，中等重要性的福利和危害时，中值净福利为1个百分点（IQR：0-2），而85％的净福利为正净净福利。具有高龄和脆弱的参与者，尽管在两个模拟中都遭受了更大的伤害，但降低BP的净收益更大，而一夫多妻制的人则在将福利视为比危害更为重要时具有更大的净收益（所有比较的p <0.001）。但是，净福利的幅度根据估计的风险和模拟偏好而有所不同。
Mitra S. Jamshidian (https://orcid.org/0000-0002-1849-0082) [1];Rebecca Scherzer [2];Michelle M. Estrella [3];Richard L. Kravitz [4];Rebecca S. Boxer [5];Daniel J. Tancredi [6];Jarett D. Berry [7];James A. de Lemos [8];Charles Ginsberg [9];Joachim H. Ix [10];Michael G. Shlipak [11];Simon B. Ascher (https://orcid.org/0000-0003-3465-4208) [12];. Individualized Net Benefit of Intensive Blood Pressure Lowering Among Community‐Dwelling Older Adults in SPRINT[J]. Journal of the American Geriatrics Society, 2025,73(5): 1441-1453