Department of Cardiology, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands.
Eur J Heart Fail. 2011 Sep;13(9):961-7. doi: 10.1093/eurjhf/hfr060. Epub 2011 May 28.
We aimed to determine the relation between baseline systolic blood pressure (SBP), change in SBP, and worsening renal function (WRF) in acute heart failure (AHF) patients enrolled in the Pre-RELAX-AHF trial.
The Pre-RELAX-AHF study enrolled 234 patients within 16 h of admission (median 7 h) for AHF and randomized them to relaxin given intravenous (i.v.) for 48 h or placebo. Blood pressure was measured at baseline, at 3, 6, 9, 12, 24, 36, and 48 h and at 3, 4, and 5 days after enrolment. Worsening renal function was defined as a serum creatinine increase of ≥0.3 mg/dL by Day 5. Worsening renal function was found in 68 of the 225 evaluable patients (30%). Patients with WRF were older (73.5 ± 9.4 vs. 69.1 ± 10.6 years; P= 0.003), had a higher baseline SBP (147.3 ± 19.9 vs. 140.8 ± 16.7 mmHg; P= 0.01), and had a greater early drop in SBP (37.9 ± 16.0 vs. 31.4 ± 12.2 mmHg; P= 0.004). In a multivariable model, higher age, higher baseline creatinine, and a greater early drop in SBP, but not baseline SBP, remained independent predictors of WRF. Furthermore, WRF was associated with a higher Day 60 (P= 0.01), and Day 180 (P= 0.003) mortality.
Worsening renal function in hospitalized AHF patients is related to a poor clinical outcome and is predicted by a greater early drop in SBP. Trial registration clinicaltrials.gov identifier NCT00520806.
我们旨在确定纳入 Pre-RELAX-AHF 试验的急性心力衰竭（AHF）患者的基线收缩压（SBP）、SBP 变化与肾功能恶化（WRF）之间的关系。
Pre-RELAX-AHF 研究纳入了 234 例 AHF 入院后 16 小时内（中位数为 7 小时）的患者，并将其随机分为静脉内（i.v.）给予松弛素 48 小时或安慰剂组。在基线、3、6、9、12、24、36 和 48 小时以及入组后 3、4 和 5 天测量血压。WRF 定义为第 5 天血清肌酐增加≥0.3 mg/dL。在 225 例可评估患者中，有 68 例（30%）出现 WRF。WRF 患者年龄较大（73.5±9.4 岁 vs. 69.1±10.6 岁；P=0.003），基线 SBP 较高（147.3±19.9mmHg vs. 140.8±16.7mmHg；P=0.01），且 SBP 早期下降幅度较大（37.9±16.0mmHg vs. 31.4±12.2mmHg；P=0.004）。在多变量模型中，较高的年龄、较高的基线肌酐和 SBP 的早期更大降幅，但不是基线 SBP，仍然是 WRF 的独立预测因素。此外，WRF 与第 60 天（P=0.01）和第 180 天（P=0.003）死亡率较高相关。
住院 AHF 患者的肾功能恶化与不良临床结局相关，并且可以通过 SBP 的早期更大降幅来预测。
clinicaltrials.gov 标识符 NCT00520806。
