Estimated Stroke-Free Survival of Folic Acid Therapy for Hypertensive Adults,Hypertension

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Estimated Stroke-Free Survival of Folic Acid Therapy for Hypertensive Adults
Hypertension ( IF 8.3 ) Pub Date : 2020-02-01 , DOI: 10.1161/hypertensionaha.119.14102
Tiantian Zhang _{1,

2,

3} , Tengfei Lin _{1,

4} , Yang Wang ₅ , Binyan Wang _{6,

7} , Xianhui Qin ₆ , Feng Xie _{8,

9,

10} , Yimin Cui ₁₁ , Yong Huo ₁₂ , Xiaobin Wang ₁₃ , Zugui Zhang ₁₄ , Jie Jiang ₁

Affiliation

From the College of Pharmacy (T.Z., T.L., J.J.), Jinan University, Guangzhou, China.
International Cooperative Laboratory of Traditional Chinese Medicine Modernization and Innovative Drug Development of Chinese Ministry of Education (MOE) (T.Z.), Jinan University, Guangzhou, China.
Guangzhou Huabo Biopharmaceutical Research Institute, China (T.Z.).
Beijing Advanced Innovation Center for Food Nutrition and Human Health, College of Food Science and Nutritional Engineering, China Agricultural University, China (T.L.).
Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, CA (Y.W.).
National Clinical Research Study Center for Kidney Disease; the State Key Laboratory for Organ Failure Research; Renal Division, Nanfang Hospital, Southern Medical University, Guangzhou, China (B.W., X.Q.).
Shenzhen Evergreen Medical Institute, China (B.W.).
Department of Clinical Epidemiology and Biostatistics (F.X.).
Centre for Health Economics and Policy Analysis (F.X.), McMaster University, Hamilton, Ontario, Canada.
Program for Health Economics and Outcomes Research, Hamilton, Ontario, Canada (F.X.).
Department of Pharmacy (Y.C.), Peking University First Hospital, Beijing, China.
Department of Cardiology (Y.H.), Peking University First Hospital, Beijing, China.
Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland (X.W.).
Christiana Care Health System, Newark, Delaware (Z.Z.).

Supplemental Digital Content is available in the text. The CSPPT (China Stroke Primary Prevention Trial) demonstrated a significant risk reduction of first stroke in hypertensive patients treated with enalapril plus folic acid compared with those with enalapril alone, but the lifetime stroke-free survival associated with the treatment is unknown. By establishing adjusted models for competing risks and an age-based time scale using data from 19 053 participants of the CSPPT, we estimated lifetime incremental stroke-free survival for enalapril-folic acid versus enalapril alone. Compared with enalapril alone, the enalapril plus folic acid treatment projected a mean lifetime stroke-free survival gain of 1.75 months, with an interquartile range from 0.73 to 2.39 months and the maximum gain up to 12.95 months. Subgroup analyses showed greater gain in stroke-free survival in younger, male patients, those with lower baseline folate levels, higher baseline systolic blood pressure, higher baseline total cholesterol and blood glucose, and with MTHFR (methylenetetrahydrofolate reductase) C677T CT or TT genotype. Overall, besides significant benefit in certain subgroups, enalapril plus folic acid treatment for hypertensive patients is associated with a modest gain in lifetime stroke-free survival, compared with enalapril alone.

更新日期：2020-02-01

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