Danelich Ilya M, Reed Brent N, Sueta Carla A
Clinical Pharmacist, Department of Pharmacy, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
Curr Cardiol Rev. 2015;11(1):4-9. doi: 10.2174/1573403x09666131117164934.
Heart failure (HF) is an epidemic associated with significant morbidity and mortality, affecting over 5 million people in the United States and 1-2% of the population worldwide. Observational studies have suggested that a healthy lifestyle can reduce HF risk. Although no clinical trials have targeted the prevention of HF as a primary endpoint, many have evaluated outcomes associated with the development of symptomatic disease (i.e., progression to HF, HF hospitalization or death) as secondary endpoints. Blood pressure treatment represents the most effective strategy in preventing heart failure; each 5 mm Hg decrease in systolic blood pressures reduces the risk of HF development by 24%. Thiazide diuretics appear to be the most efficacious agents in patients with hypertension. Angiotensin converting enzyme inhibitors and angiotensin-II receptor blockers are first line agents for patients with chronic atherosclerosis, diabetes, or chronic kidney disease. Beta blockers appear less effective as single agents and cardioselective agents are preferred. Calcium channel blockers, specifically non-dihydropyridines, should be avoided and alpha blockers should not be used to reduce HF risk.
心力衰竭（HF）是一种与高发病率和死亡率相关的流行病，在美国影响着超过500万人，在全球人口中占1%-2%。观察性研究表明，健康的生活方式可以降低心力衰竭风险。虽然尚无临床试验将预防心力衰竭作为主要终点，但许多试验已将与有症状疾病发展相关的结果（即进展为心力衰竭、心力衰竭住院或死亡）作为次要终点进行评估。血压治疗是预防心力衰竭最有效的策略；收缩压每降低5毫米汞柱，心力衰竭发生风险降低24%。噻嗪类利尿剂似乎是高血压患者中最有效的药物。血管紧张素转换酶抑制剂和血管紧张素II受体阻滞剂是患有慢性动脉粥样硬化、糖尿病或慢性肾病患者的一线用药。β受体阻滞剂作为单一药物似乎效果较差，优选使用心脏选择性药物。应避免使用钙通道阻滞剂，特别是非二氢吡啶类，且不应使用α受体阻滞剂来降低心力衰竭风险。
