成田 圭佑

BACKGROUND: Postprandial hypotension (PPH) may contribute to falls among older adults, particularly those taking antihypertensive medication. However, evidence on this association in community-dwelling populations is limited. Since ambulatory blood pressure (BP) monitoring captures BP during daily activities, it may provide accurate assessments of PPH outside the clinic setting. METHODS: This prospective cohort study examined the association between PPH and fall risk among community-dwelling adults aged ≥65 years taking antihypertensive medication. At baseline, participants underwent 24-hour ambulatory BP monitoring; subsequently, they completed monthly fall calendars during a 12-month follow-up. PPH by systolic BP (SBP; systolic PPH) was defined as a postprandial SBP decline, mean SBP during the hour before the meal minus the minimum SBP during the 2 hours after the meal, following any meal of ≥20 mm Hg, or a decrease to SBP ≤90 mm Hg when preprandial SBP was ≥100 mm Hg. RESULTS: Among 626 participants (mean±SD age, 74.6±6.2 years; 56.1% women), 442 (70.6%) experienced systolic PPH. The mean±SD number of meals was 2.6±0.8 during the ambulatory BP monitoring period. During the 12-month follow-up, falls occurred in 169 of 442 (38.2%) participants with systolic PPH and 70 of 184 (38.0%) participants without systolic PPH. Systolic PPH was not associated with fall risk (adjusted hazard ratio, 0.93 [95% CI, 0.69-1.26]). A restricted cubic spline analysis demonstrated no evidence of an association between the largest postprandial SBP decline across all meals and fall risk. CONCLUSIONS: In this cohort study, PPH identified by ambulatory BP monitoring was common but not associated with risk of falls.

BACKGROUND: The Predicting Risk of Cardiovascular Disease Events (PREVENT) equations may provide more precise risk stratification than older calculators by incorporating estimated glomerular filtration rate, excluding race, and capturing total cardiovascular disease (CVD) events including heart failure. OBJECTIVES: The aim of this study was to quantify the relative and absolute benefits and harms of intensive vs standard systolic blood pressure (SBP) treatment by the new PREVENT risk levels. METHODS: A secondary analysis of SPRING (Systolic Blood Pressure Intervention Trial) was performed among participants without prevalent CVD and with complete data to calculate the baseline PREVENT 10-year risk for total CVD, which was categorized as low or borderline (<7.5%), intermediate (7.5% to <20%), and high (≥20%). Across these groups, the HRs and 4-year absolute risk differences were estimated for the effect of intensive (<120 mm Hg) vs standard (<140 mm Hg) SBP treatment on the primary composite outcome (myocardial infarction, acute coronary syndrome, stroke, heart failure, or CVD death) and treatment-related serious adverse events. RESULTS: Of 6,554 SPRINT participants analyzed (mean age 65 years, 37% women, 53% non-Hispanic White), the median PREVENTbase 10-year risk for total CVD was 13% (Q1-Q3: 9%-19%). Respectively, 16%, 62%, and 22% were categorized as low or borderline, intermediate, and high risk. Over a median follow-up period of 3.86 years, the HRs for CVD events comparing intensive vs standard treatment were 0.74 (95% CI: 0.33-1.66) for low or borderline risk, 0.70 (95% CI: 0.52-0.93) for intermediate risk, and 0.85 (95% CI: 0.60-1.20) for high risk (P for interaction = 0.68). The 4-year absolute risk difference was 0.002 for low or borderline, 0.015 for intermediate, and 0.024 for high risk. Similarly, there was no evidence of interaction on the relative risk scale across PREVENT strata for serious adverse events with intensive vs standard treatment (low or borderline: HR: 1.12 [95% CI: 0.53-2.38]; intermediate: HR: 1.66 [95% CI: 1.24-2.24]; high: HR: 1.28 [95% CI: 0.87-1.87]; P for interaction = 0.44). CONCLUSIONS: Among SPRINT participants without baseline CVD, the relative risk reduction with intensive vs standard SBP treatment was consistent across PREVENT risk strata. However, the absolute risks varied several-fold from the low- or borderline-risk group to the high-risk group. These findings underscore the utility of PREVENT to identify those most likely to derive substantial absolute benefit from intensive SBP control for primary prevention.