University Heart Centre, Cardiology, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland.
Department of Biostatistics, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland.
Eur J Heart Fail. 2017 Jul;19(7):837-842. doi: 10.1002/ejhf.805. Epub 2017 Mar 27.
Chronic heart failure (CHF) is the final stage of many heart diseases. To improve outcomes, important risk factors for adverse clinical events in the CHF population need to be identified. The aim of the present study was to delineate the influence of long-term blood pressure (BP) changes on prognosis and mortality in a real-world cohort of CHF patients.
This is a retrospective longitudinal analysis. Repeated office BP measurements were scheduled during follow-up visits every 3-6 months. The primary endpoint was time to death or heart transplantation (HTx). A Cox regression with time-dependent strata was used to analyse the effect of systolic BP (SBP) values and its change during follow-up on the primary endpoint. A total of 927 patients presented with a median survival of 7.7 [95% confidence interval (CI) 6.6-9.8] years. During follow-up, 220 patients died and 70 patients underwent HTx. The BP stratum with the most stable values showed the best survival. Blood pressure changes with an increase or decrease greater than ±10 mmHg per year led to a significantly worse outcome [hazard ratio (HR) 1.8 and 2.0, respectively]. The stratum with the lowest SBP levels (<90 mmHg) had the highest mortality. Multiple regression analysis showed a HR factor of 17 (95% CI 9.7-29) in comparison with the stratum with SBP ≥130 mmHg.
Low SBP (<90 mmHg) and pronounced long-term changes in SBP were associated with poor survival in patients with CHF. Additional prospective studies are warranted to further specify optimal BP targets in patients with CHF.
慢性心力衰竭（CHF）是许多心脏病的终末阶段。为了改善预后，需要确定 CHF 人群中导致不良临床事件的重要危险因素。本研究旨在描述长期血压（BP）变化对真实世界 CHF 患者预后和死亡率的影响。
这是一项回顾性纵向分析。在随访期间，每 3-6 个月安排一次诊室 BP 测量。主要终点是死亡或心脏移植（HTx）时间。采用时依分层 Cox 回归分析 SBP 值及其在随访期间的变化对主要终点的影响。共纳入 927 例患者，中位生存时间为 7.7 [95%置信区间（CI）6.6-9.8]年。随访期间，220 例患者死亡，70 例患者行 HTx。BP 稳定值的分层显示出最佳的生存。BP 每年增加或减少>±10mmHg 的变化导致预后显著恶化[风险比（HR）分别为 1.8 和 2.0]。SBP 水平最低（<90mmHg）的分层死亡率最高。多因素回归分析显示，与 SBP ≥130mmHg 的分层相比，HR 因素为 17（95%CI 9.7-29）。
CHF 患者 SBP 较低（<90mmHg）和 SBP 长期显著变化与生存不良相关。需要进一步开展前瞻性研究以明确 CHF 患者的最佳 BP 目标。
