Lee Douglas S, Ghosh Nina, Floras John S, Newton Gary E, Austin Peter C, Wang Xuesong, Liu Peter P, Stukel Thérèse A, Tu Jack V
Institute for Clinical Evaluative Sciences, Ontario, Canada.
Circ Heart Fail. 2009 Nov;2(6):616-23. doi: 10.1161/CIRCHEARTFAILURE.109.869743. Epub 2009 Sep 24.
Higher blood pressure in acute heart failure has been associated with improved survival; however, the relationship between blood pressure and survival in stabilized patients at hospital discharge has not been established.
In 7448 patients with heart failure (75.2+/-11.5 years; 49.9% men) discharged from the hospital in Ontario, Canada, we examined the association of systolic blood pressure (SBP) and diastolic blood pressure with long-term survival. Parametric survival analysis was performed, and survival time ratios were determined according to discharge blood pressure group. A total of 25 427 person-years of follow-up were examined. In those with left ventricular ejection fraction < or =40%, median survival was decreased by 17% (survival time ratio, 0.83; 95% CI, 0.71 to 0.98; P=0.029) when discharge SBP was 100 to 119 mm Hg and decreased by 23% (survival time ratio, 0.77; 95% CI, 0.62 to 0.97; P=0.024) when discharge SBP was <100 mm Hg, compared with those in the reference range of 120 to 139 mm Hg. Survival time ratios were 0.75 (95% CI, 0.60 to 0.92; P=0.007) and 0.75 (95% CI, 0.53 to 1.07; P=0.12) when discharge SBPs were 140 to 159 and > or =160 mm Hg, respectively. In those with left ventricular ejection fraction >40%, survival time ratios were 0.69 (95% CI, 0.51 to 0.93), 0.83 (95% CI, 0.71 to 0.99), 0.95 (95% CI, 0.80 to 1.14), and 0.76 (95% CI, 0.61 to 0.95) for discharge SBPs <100, 100 to 119, 140 to 159, and > or =160 mm Hg, respectively.
In this long-term population-based study of patients with heart failure, the association of discharge SBP with mortality followed a U-shaped distribution. Survival was shortened in those with reduced or increased values of discharge SBP.
急性心力衰竭患者血压升高与生存率提高相关；然而，出院时病情稳定的患者血压与生存率之间的关系尚未明确。
在加拿大安大略省出院的7448例心力衰竭患者（年龄75.2±11.5岁；男性占49.9%）中，我们研究了收缩压（SBP）和舒张压与长期生存率的关联。进行了参数生存分析，并根据出院时血压分组确定生存时间比。共进行了25427人年的随访。在左心室射血分数≤40%的患者中，出院时SBP为100至119mmHg时，中位生存期缩短17%（生存时间比为0.83；95%CI为0.71至0.98；P=0.029），出院时SBP<100mmHg时，中位生存期缩短23%（生存时间比为0.77；95%CI为0.62至0.97；P=0.024），而参考范围为120至139mmHg。出院时SBP为140至159mmHg和≥160mmHg时，生存时间比分别为0.75（95%CI为0.60至0.92；P=0.007）和0.75（95%CI为0.53至1.07；P=0.12）。在左心室射血分数>40%的患者中，出院时SBP<100、100至119、140至159和≥160mmHg时的生存时间比分别为0.69（95%CI为0.51至0.93）、0.83（95%CI为0.71至0.99）、0.95（95%CI为0.80至1.14）和0.76（95%CI为0.61至0.95）。
在这项基于人群的心力衰竭患者长期研究中，出院时SBP与死亡率的关联呈U形分布。出院时SBP值降低或升高的患者生存率缩短。
