β受体阻滞剂长期处方可延缓高血压合并射血分数保留的心力衰竭患者的疾病进展：一项回顾性观察队列研究。
Long-term prescription of beta-blocker delays the progression of heart failure with preserved ejection fraction in patients with hypertension: A retrospective observational cohort study.
作者信息
Gu Jun, Fan Yu-Qi, Bian Ling, Zhang Hui-Li, Xu Zuo-Jun, Zhang Yang, Chen Qi-Zhi, Yin Zhao-Fang, Xie Yu-Shui, Wang Chang-Qian
机构信息
Department of Cardiology, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China
Department of Cardiology, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China.
出版信息
Eur J Prev Cardiol. 2016 Sep;23(13):1421-8. doi: 10.1177/2047487316636260. Epub 2016 Feb 25.
BACKGROUND
Hypertension complicated with left ventricular hypertrophy (LVH) and diastolic dysfunction is one of the most common risks for heart failure with preserved ejection fraction (HFpEF). This study was designed to evaluate the influences of long-term beta-blocker prescription in these patients.
METHODS
This retrospective analysis included eligible patients diagnosed with hypertension, LVH (left ventricular (LV) mass index >125 g/m(2) for men and >110 g/m(2) for women) and suspected diastolic dysfunction (E/E' ratio between 8 and 15) and without clinical signs or symptoms of heart failure in our hospital medical record database (January 2005-December 2009). A total of eligible 1498 patients were enrolled, of whom 803 received beta-blocker prescription and 695 accepted non-beta-blocker therapy.
RESULTS
With a median follow-up of 7.2 years, the new-onset symptomatic HFpEF occurred in 48 of 803 patients in the beta-blocker group (6.0%) and 92 of 695 patients in the non-beta-blocker group (13.2%, p < 0.001). Beta-blockers also generated more prominent improvement in diastolic function and LVH. And Cox proportional hazards model revealed that beta-blocker (hazard ratio (HR) 0.327, 95% confidence interval (CI): 0.121-0.540, p = 0.009) or angiotensin-converting enzyme inhibitor/angiotensin II receptor blocker (ACEI/ARB) exposure (HR 0.422, 95% CI: 0.210-0.699, p = 0.015) was associated with a reduced risk of new onset of symptomatic HFpEF, and the elevation of LVMI (HR 1.210, 95% CI: 1.069-1.362, p = 0.040) or E/E' (HR 1.398, 95% CI: 1.306-1.541, p = 0.032) was associated with a high risk of new onset of symptomatic HFpEF.
CONCLUSIONS
Long-term beta-blocker exposure was associated with protective effects in terms of the incidence of new-onset symptomatic HFpEF, LV diastolic dysfunction and LVH, which might be beneficial for the delay of HFpEF progression.
背景
高血压合并左心室肥厚（LVH）和舒张功能障碍是射血分数保留的心力衰竭（HFpEF）最常见的风险之一。本研究旨在评估长期使用β受体阻滞剂对这些患者的影响。
方法
这项回顾性分析纳入了我院病历数据库（2005年1月至2009年12月）中诊断为高血压、LVH（男性左心室（LV）质量指数>125 g/m²，女性>110 g/m²）且疑似舒张功能障碍（E/E'比值在8至15之间）且无心力衰竭临床体征或症状的符合条件的患者。总共纳入了1498例符合条件的患者，其中803例接受了β受体阻滞剂治疗，695例接受了非β受体阻滞剂治疗。
结果
中位随访7.2年，β受体阻滞剂组803例患者中有48例发生新发症状性HFpEF（6.0%），非β受体阻滞剂组695例患者中有92例发生（13.2%，p<0.001）。β受体阻滞剂在舒张功能和LVH方面也产生了更显著的改善。Cox比例风险模型显示，β受体阻滞剂（风险比（HR）0.327，95%置信区间（CI）：0.121 - 0.540，p = 0.009）或血管紧张素转换酶抑制剂/血管紧张素II受体阻滞剂（ACEI/ARB）暴露（HR 0.422，95% CI：0.210 - 0.699，p = 0.015）与新发症状性HFpEF风险降低相关，而LVMI升高（HR 1.210，95% CI：1.069 - 1.362，p = 0.040）或E/E'升高（HR 1.398，95% CI：1.306 - 1.541，p = 0.032）与新发症状性HFpEF高风险相关。
结论
长期暴露于β受体阻滞剂在新发症状性HFpEF、LV舒张功能障碍和LVH发生率方面具有保护作用，这可能有利于延缓HFpEF的进展。
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