1st Department of Internal Medicine - Cardiology, University Hospital Brno, Brno, Czech Republic.
Eur J Intern Med. 2011 Dec;22(6):591-6. doi: 10.1016/j.ejim.2011.09.006. Epub 2011 Oct 12.
The effect of previous long-term hypertension on mortality in acute heart failure (HF), regardless of blood pressure values, has not been well studied.
Acute Heart Failure Database (AHEAD) - Czech HF registry enrolled 4153 consecutive patients with acute HF. We excluded severe forms (cardiogenic shock, pulmonary oedema, right HF) and analysed 2421 patients with known presence or absence of previous hypertension. Demographic, clinical and laboratory profile, treatment and mortality rates were assessed and predictors of outcome were identified.
Patients with previous hypertension (71.5%) were older, more of female gender, with worse pre-hospitalisation NYHA class, increased incidence of co-morbidities and higher left ventricular ejection fraction (LVEF). Although in-hospital mortality was similar in both cohorts (2.6%), survival at 1, 2 and 3-year was worse in the hypertensive group (75.6%, 65.9% and 58.7% vs. 80.7%, 74.2% and 69.8%; P<0.001). Nevertheless, hypertension was not associated with mortality in multivariate analysis and stronger predictors of outcome were identified (P<0.05): new-onset acute HF [hazard ratio (HR) 0.62] and increased body mass index (HR 0.68) proved to have a protective role. Advanced age (HR 1.86), diabetes (HR 1.45), lower LVEF (HR 1.28) and admission blood pressure (HR 1.54), elevated serum creatinine (HR 1.63), hyponatremia (HR 1.77) and anaemia (HR 1.40) were associated with worse survival.
Antecedent hypertension is frequent in patients with acute HF and contributes to organ and vascular impairment. However its presence has no independent influence on short- and medium-term mortality, which is influenced by other related co-morbidities.
既往长期高血压对急性心力衰竭（HF）死亡率的影响，无论血压值如何，都尚未得到很好的研究。
急性心力衰竭数据库（AHEAD）-捷克心力衰竭登记处纳入了 4153 例连续急性心力衰竭患者。我们排除了严重形式（心源性休克、肺水肿、右心衰竭），并分析了已知存在或不存在既往高血压的 2421 例患者。评估了人口统计学、临床和实验室特征、治疗和死亡率，并确定了预后的预测因素。
既往有高血压的患者（71.5%）年龄较大，女性比例较高，住院前 NYHA 分级较差，合并症发生率较高，左心室射血分数（LVEF）较高。尽管两组的院内死亡率相似（2.6%），但高血压组的 1 年、2 年和 3 年生存率较差（75.6%、65.9%和 58.7% vs. 80.7%、74.2%和 69.8%；P<0.001）。然而，高血压在多变量分析中与死亡率无关，并且确定了更强的预后预测因素（P<0.05）：新发急性 HF[风险比（HR）0.62]和体重指数增加（HR 0.68）被证明具有保护作用。年龄较大（HR 1.86）、糖尿病（HR 1.45）、较低的 LVEF（HR 1.28）和入院血压（HR 1.54）、血清肌酐升高（HR 1.63）、低钠血症（HR 1.77）和贫血（HR 1.40）与生存率较差相关。
既往高血压在急性心力衰竭患者中很常见，导致器官和血管损伤。然而，它的存在对短期和中期死亡率没有独立影响，死亡率受其他相关合并症的影响。
