BACKGROUND The optimal timing for initiating intensive systolic blood pressure (SBP) treatment remains unclear. While longer hypertension duration is positively associated with increased cardiovascular disease risk, it is unknown whether patients with prolonged hypertension can derive similar benefits from intensive SBP treatment. METHODS From the STEP trial (Strategy of Blood Pressure Intervention in the Elderly Hypertensive Patients), 8442 participants with complete hypertension duration data were categorized by hypertension duration ≤5 years, 5 to 10 years, 10 to 15 years, and >15 years. The primary outcome was a composite of cardiovascular events. Hazard ratios were calculated using the Fine-Gray subdistribution hazard model. RESULTS The incidences of the primary outcome increased significantly in patients with hypertension over 15 years than those <5 years in the standard SBP treatment group (adjusted hazard ratios, 1.68 [95% CI, 1.11-2.56]) but not in the intensive treatment group. Each 1-year increase in hypertension duration continuously increased the adjusted risk of major cardiovascular events by 4% (95% CI, 1.01-1.08) up to 20 years, plateauing at an adjusted hazard ratio of 2.27 (95% CI, 1.28-4.04). After intensive SBP treatment, the incidences of major cardiovascular events were similar across different hypertension duration groups, which were 2.22%, 1.69%, 3.02%, and 2.52%, respectively (P>0.05). Subgroup analyses indicated a potential sex difference in this relationship between hypertension duration and the primary outcome in the standard SBP treatment group (Pinteraction=0.05). CONCLUSIONS Initiating intensive SBP treatment at any stage of hypertension duration could reduce cardiovascular disease risk to a comparable level. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT03015311.

中文翻译：

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高血压持续时间对强化血压控制对心血管益处的影响。


背景 开始强化收缩压（SBP）治疗的最佳时机仍不清楚。虽然高血压持续时间较长与心血管疾病风险增加呈正相关，但尚不清楚长期高血压患者是否能从强化 SBP 治疗中获得类似的益处。方法 在STEP试验（老年高血压患者血压干预策略）中，8442名具有完整高血压病程数据的参与者按照高血压病程≤5年、5至10年、10至15年和>15年进行分类。主要结局是心血管事件的综合结果。使用细灰色次分布风险模型计算风险比。结果15岁以上高血压患者主要结局发生率较<5 id=0>0.05)显着增加。亚组分析表明，标准 SBP 治疗组中高血压持续时间与主要结局之间的关系存在潜在的性别差异（Pinteraction=0.05）。结论 在高血压病程的任何阶段开始强化 SBP 治疗都可以将心血管疾病风险降低到相当的水平。注册网址：https://www.clinicaltrials.gov；唯一标识符：NCT03015311。