Cheng Richard K, Horwich Tamara B, Fonarow Gregg C
Department of Medicine, UCLA Medical Center, Los Angeles, California, USA.
Am J Cardiol. 2008 Dec 15;102(12):1698-705. doi: 10.1016/j.amjcard.2008.07.058. Epub 2008 Sep 20.
High systolic blood pressure (SBP) is a predictor of survival for patients with heart failure (HF). Whether SBP predicts survival in both ischemic and nonischemic HF has not been well examined. We analyzed 2,178 patients with advanced HF (47.3% ischemic etiology, 75.5% men, 93.5% New York Heart Association class III or IV, age 52 +/- 13, left ventricular ejection fraction 24 +/- 9%) referred to a university center between 1983 and 2006. SBP and invasive hemodynamic variables were recorded after optimization of medical therapy. Patients were divided into SBP quartiles (<or=90, 91 to 100, 101 to 112, >or=113 mm Hg) based on SBP frequency. Survival free from death or urgent transplant in ischemic versus nonischemic HF was 53.2% versus 61.1% at 2 years. Higher SBP quartile was associated with increased survival in the total cohort and in subgroups of both nonischemic and ischemic HF. On multivariate analysis adjusting for age, left ventricular ejection fraction, cholesterol, gender, diabetes mellitus, pulmonary capillary wedge pressure, cardiac index, New York Heart Association class, beta-blocker use, angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker use, statin use, and smoking history, relative risk (95% confidence interval) of death or urgent transplant at 2 years for quartile 1 compared with quartile 4 was 1.9 (1.4 to 2.6) in the total cohort, 1.6 (1.1 to 2.5) in nonischemic HF, and 2.4 (1.5 to 3.7) in ischemic HF. In conclusion, SBP predicts HF survival in both ischemic and nonischemic HF independent of other risk factors and invasive hemodynamic variables.
收缩压升高是心力衰竭（HF）患者生存的一个预测指标。收缩压是否能预测缺血性和非缺血性心力衰竭患者的生存情况尚未得到充分研究。我们分析了1983年至2006年间转诊至一所大学中心的2178例晚期心力衰竭患者（缺血性病因占47.3%，男性占75.5%，纽约心脏协会III或IV级占93.5%，年龄52±13岁，左心室射血分数24±9%）。在优化药物治疗后记录收缩压和有创血流动力学变量。根据收缩压频率将患者分为收缩压四分位数组（≤90、91至100、101至112、≥113 mmHg）。缺血性与非缺血性心力衰竭患者2年时无死亡或紧急移植的生存率分别为53.2%和61.1%。较高的收缩压四分位数与总队列以及非缺血性和缺血性心力衰竭亚组的生存率增加相关。在多变量分析中，校正年龄、左心室射血分数、胆固醇、性别、糖尿病、肺毛细血管楔压、心脏指数、纽约心脏协会分级、β受体阻滞剂使用、血管紧张素转换酶抑制剂或血管紧张素II受体阻滞剂使用、他汀类药物使用和吸烟史后，总队列中第1四分位数与第4四分位数相比2年时死亡或紧急移植的相对风险（95%置信区间）为1.9（1.4至2.6），非缺血性心力衰竭中为1.6（1.1至2.5），缺血性心力衰竭中为2.4（1.5至3.7）。总之，收缩压可独立于其他危险因素和有创血流动力学变量预测缺血性和非缺血性心力衰竭患者的生存情况。
