目的 探讨不同降压水平对老年高血压患者复合心血管事件的影响。 方法 采用回顾性队列研究方法，对2010年1 月至2020年1月的老年高血压患者（65 ~ 95岁）449例的临床资料进行分析。根据患者入组前1年的临床实际降压数据分入1组224例（收缩压110 ~ 130 mmHg）和2组225例（收缩压130 ~ 150 mmHg），以两组患者主要复合心血管结局事件包括急性冠脉综合征、卒中、急性失代偿性心力衰竭、心血管死亡为主要研究重点。采用Fine-Gray方法比较竞争风险，应用Cox比例风险模型计算死亡风险，分析两组血压水平对老年高血压患者复合心血管事件的影响。 结果 1组（收缩压110 ~ 130 mmHg）21例（9.3%）患者发生了主要复合心血管结局事件，2组（收缩压130 ~ 150 mmHg）28例（12.4%）患者发生了主要复合心血管结局事件（HR = 0.75， 95%CI： 0.61 ~ 0.94， P = 0.006）。1组的主要复合心血管事件发生率显著低于2组，绝对差异3.1%。主要复合结局事件中的单项事件的结果也有利于1组：急性冠脉综合征（HR = 0.71，95%CI：0.48 ~ 0.96）、卒中（HR = 0.68，95%CI：0.46 ~ 0.95）、急性失代偿性心力衰竭（HR = 0.27，95%CI：0.08 ~ 0.98）、心血管死亡（HR = 0.57， 95%CI：0.39 ~ 0.85）、全因死亡（HR = 0.93，95%CI：0.54 ~ 0.97），1组的获益均显著优于2组。 结论 对年龄超过65岁的高血压患者，收缩压110 ~ 130 mmHg较收缩压130 ~ 150 mmHg显著降低心血管事件的发生率。

Objective To investigate the effect of different antihypertensive therapy levels on composite cardiovascular events in older patients with hypertension. Methods This retrospective study recruited 449 older patients with hypertension （65 ~ 95 years old） who were taking continuous antihypertensive treatment between January 2010 and January 2020. The patients were divided into two groups according to practical blood pressure data for at least one year： group1 224 cases （SBP 110 ~ 130 mmHg） and group 2 225 cases （SBP 130 ~ 150 mmHg）. The primary composite outcome was a composite of acute coronary syndrome， stroke， acute decompensated heart failure， and death from cardiovascular causes. The hazard ratios， 95% confidence intervals， and P value were estimated using the Fine?Gray subdistribution hazard model. The Cox regression model was employed for deaths from any cause. To analyze the effect of two groups antihypertensive therapy levels on the risk of cardiovascular events. Results Primary composite outcome events occurred in 21 of 224 patients （9.3%） in group1（SBP 110 ~ 130 mmHg）， as compared with 28 of 225 patients （12.4%） in group 2 （SBP 130 ~ 150 mmHg） （HR = 0.75， 95%CI： 0.61 ~ 0.94， P = 0.06）. The incidence of primary composite outcome events was significantly lower in group1 than in group 2， with an absolute difference of 3.1 percentage points. The results for individual event of the primary composite outcomes also favored group1. acute coronary syndrome （HR = 0.71， 95%CI： 0.48 ~ 0.96）， stroke （HR = 0.68， 95%CI： 0.46 ~ 0.95）， acute decompensated heart failure （HR = 0.27， 95%CI： 0.08 ~ 0.98）， cardiovascular death （HR = 0.57， 95%CI： 0.39 ~ 0.85）， and all cause death （HR = 0.93， 95%CI： 0.54 ~ 0.97）. The benefit of group1 was significantly better than group 2. Conclusion Systolic blood pressure of 110 ~ 130 mmHg significantly reduces the incidence of cardiovascular events in hypertensive patients over the age of 65 when compared to 130 ~ 150 mmHg.