血红蛋白在心电图显示左心室肥厚的高血压患者中的预后重要性：氯沙坦干预降低高血压终点事件（LIFE）研究

Prognostic importance of hemoglobin in hypertensive patients with electrocardiographic left ventricular hypertrophy: the Losartan Intervention For End point reduction in hypertension (LIFE) study.

作者信息

Olsen Michael Hecht, Wachtell Kristian, Beevers Gareth, Dahlöf Björn, Devereux Richard B, de Faire Ulf, Fyhrquist Frej, Ibsen Hans, Kjeldsen Sverre E, Lederballe-Pedersen Ole, Lindholm Lars H, Narayan Puneet, Nieminen Markku S, Omvik Per, Oparil Suzanne, Wedel Hans

机构信息

Department of Internal Medicine, Glostrup Hospital, University of Copenhagen, Glostrup, Denmark.

出版信息

Am Heart J. 2009 Jan;157(1):177-84. doi: 10.1016/j.ahj.2008.08.011. Epub 2008 Oct 17.

DOI:10.1016/j.ahj.2008.08.011

PMID:19081416

Abstract

BACKGROUND

The prognostic importance of hemoglobin is controversial. We investigated the prognostic importance of baseline and in-treatment hemoglobin in the LIFE study.

METHODS

Eight thousand one hundred ninety-four LIFE patients with hypertension and left ventricular hypertrophy with available baseline hemoglobin measurements were randomized to losartan- or atenolol-based treatment and followed for 4.8 years for end points of all-cause mortality and composite of cardiovascular death, nonfatal stroke, or nonfatal myocardial infarction.

RESULTS

U-shaped relations were observed between deciles of baseline hemoglobin and all-cause mortality and the composite end point. In univariate Cox models, baseline hemoglobin in the lowest gender-specific decile (women/men: <12.5/13.4 g/dL) was associated with all-cause mortality (hazard ratio [HR] 2.01, 95% CI 1.64-2.64) and the composite end point (HR 1.53, 95% CI 1.27-1.85, both P < .001), whereas hemoglobin in the highest gender-specific decile (women/men: > or =15.0/16.2 g/dL) was not. The decrease in hemoglobin was higher (P < .001) in patients allocated to losartan- (14.3-13.8 g/dL) versus atenolol-based treatment (14.3-14.0 g/dL). In Cox models with the same gender-specific definitions for high and low hemoglobin as time-varying covariates with adjustment for treatment allocation and established risk factors and diseases, hemoglobin in the lowest decile was associated with higher rates of all-cause mortality (HR 3.03, 95% CI 1.89-4.85, P < .001) and the composite end point (HR 1.36, 95% CI 1.08-1.71, P < .01), whereas hemoglobin in the highest decile was not.

CONCLUSIONS

After adjusting for other risk factors, relatively low, but not high, hemoglobin during antihypertensive treatment was associated with higher incidence of all-cause mortality and the composite end point.

摘要

背景

血红蛋白的预后重要性存在争议。我们在 LIFE 研究中调查了基线和治疗期间血红蛋白的预后重要性。

方法

8194 例患有高血压和左心室肥厚且有可用基线血红蛋白测量值的 LIFE 患者被随机分配至基于氯沙坦或阿替洛尔的治疗组，并随访 4.8 年，观察全因死亡率以及心血管死亡、非致死性卒中或非致死性心肌梗死的复合终点。

结果

观察到基线血红蛋白十分位数与全因死亡率和复合终点之间呈 U 形关系。在单变量 Cox 模型中，处于最低性别特异性十分位数的基线血红蛋白（女性/男性：<12.5/13.4 g/dL）与全因死亡率（风险比[HR] 2.01，95%CI 1.64 - 2.64）和复合终点（HR 1.53，95%CI 1.27 - 1.85，P <.001）相关，而处于最高性别特异性十分位数的血红蛋白（女性/男性：≥15.0/16.2 g/dL）则不然。分配至氯沙坦治疗组（14.3 - 13.8 g/dL）的患者血红蛋白下降幅度高于阿替洛尔治疗组（14.3 - 14.0 g/dL）（P <.001）。在将相同性别特异性高低血红蛋白定义作为随时间变化的协变量并对治疗分配和已确定的危险因素及疾病进行调整的 Cox 模型中，处于最低十分位数的血红蛋白与更高的全因死亡率（HR 3.03，95%CI 1.89 - 4.85，P <.001）和复合终点发生率（HR 1.36，95%CI 1.08 - 1.71，P <.01）相关，而处于最高十分位数的血红蛋白则不然。