Okin Peter M, Kjeldsen Sverre E, Dahlöf Björn, Devereux Richard B
Division of Cardiology, Weill Cornell Medical College, New York, NY 10065, USA.
Circ Cardiovasc Qual Outcomes. 2011 Mar;4(2):157-64. doi: 10.1161/CIRCOUTCOMES.110.960112. Epub 2011 Feb 8.
Blacks have a higher prevalence of heart failure (HF) than nonblacks, possibly reflecting a greater burden of HF risk factors, including hypertension. Although HF incidence is significantly higher in blacks during long-term follow-up of young adults, the relationship of incident HF to race in hypertensive patients undergoing treatment is unclear.
Incident HF was evaluated in 497 black and 8199 nonblack hypertensive patients with no history of HF randomly assigned to losartan- or atenolol-based treatment. During 4.7±1.1 years mean follow-up, HF hospitalization occurred in 265 patients (3.0%); 5-year HF incidence was significantly greater in black than nonblack patients (7.0 versus 3.1%, P<0.001). In Cox multivariate analyses adjusting for randomized treatment, age, sex, the presence of the strain pattern on the baseline ECG, and other HF risk factors treated as standard covariates, and for incident myocardial infarction, in-treatment QRS duration, diastolic and systolic pressure, Cornell product, and Sokolow-Lyon voltage criteria for left ventricular hypertrophy (LVH) treated as time-varying covariates, black race remained associated with a 130% increased risk of developing new HF (hazard ratio 2.30, 95% confidence interval 1.24 to 4.28).
Incident HF is substantially more common among black than nonblack hypertensive patients. The increased risk of developing new HF in blacks persists after adjusting for the higher prevalence of HF risk factors in blacks, for treatment effects and in-treatment blood pressure, and for the known predictive value of the ECG strain pattern and in-treatment ECG LVH and QRS duration for incident HF in this population. Clinical Trial Registration- URL: http://www.clinicaltrials.gov. Unique identifier: NCT00338260.
黑人心力衰竭（HF）的患病率高于非黑人，这可能反映出包括高血压在内的HF危险因素负担更重。尽管在年轻成年人的长期随访中，黑人的HF发病率显著更高，但在接受治疗的高血压患者中，新发HF与种族的关系尚不清楚。
对497名无HF病史的黑人高血压患者和8199名非黑人高血压患者进行了新发HF评估，这些患者被随机分配接受基于氯沙坦或阿替洛尔的治疗。在平均4.7±1.1年的随访期间，265名患者（3.0%）发生了HF住院；黑人患者的5年HF发病率显著高于非黑人患者（7.0%对3.1%，P<0.001）。在Cox多变量分析中，对随机治疗、年龄、性别、基线心电图上的应变模式以及作为标准协变量处理的其他HF危险因素进行了调整，并对新发心肌梗死、治疗期间的QRS时限、舒张压和收缩压、康奈尔乘积以及作为时间变化协变量处理的左心室肥厚（LVH）的索科洛夫-里昂电压标准进行了调整，黑人种族仍然与新发HF风险增加130%相关（风险比2.30，95%置信区间为1.24至4.28）。
在高血压患者中，黑人新发HF比非黑人更为常见。在对黑人中HF危险因素的较高患病率、治疗效果和治疗期间的血压以及该人群中已知的心电图应变模式和治疗期间心电图LVH及QRS时限对新发HF的预测价值进行调整后，黑人发生新发HF的风险增加仍然存在。临床试验注册-网址：http://www.clinicaltrials.gov。唯一标识符：NCT00338260。
