Upadhya Bharathi, Rocco Michael, Lewis Cora E, Oparil Suzanne, Lovato Laura C, Cushman William C, Bates Jeffrey T, Bello Natalie A, Aurigemma Gerard, Fine Lawrence J, Johnson Karen C, Rodriguez Carlos J, Raj Dominic S, Rastogi Anjay, Tamariz Leonardo, Wiggers Alan, Kitzman Dalane W
From the Cardiovascular Medicine Section (B.U., C.J.R., D.W.K.), Nephrology Section, Department of Internal Medicine (M.R.), and Biostatistics (L.C.L.), Wake Forest School of Medicine, Winston-Salem, NC; Division of Preventive Medicine (C.E.L.) and Division of Cardiovascular Disease (S.O.), Department of Medicine, University of Alabama, Birmingham; Preventive Medicine Section, Veterans Affairs Medical Center, Memphis, TN (W.C.C.); Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, TX (J.T.B.); Cardiovascular Division, Department of Medicine, Columbia University Medical Center, New York, NY (N.A.B.); Department of Cardiology, University of Massachusetts Medical School, Worcester (G.A.); Clinical Applications and Prevention Branch, Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (L.J.F.); Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis (K.C.J.); Department of Medicine-Nephrology, George Washington University School of Medicine, DC (D.S.R.); Division of Nephrology, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles (A.R.); University of Miami Miller School of Medicine, FL and Veterans Affairs Medical Center, Miami, FL (L.T.); and UH Harrington Heart and Vascular Institute, Cleveland Medical Center, OH (A.W.).
Circ Heart Fail. 2017 Apr;10(4). doi: 10.1161/CIRCHEARTFAILURE.116.003613.
Acute decompensated heart failure (ADHF) was a frequent common outcome in SPRINT (Systolic Blood Pressure Intervention Trial). We examined whether there was differential reduction in ADHF events from intensive blood pressure [BP] treatment among the 6 key, prespecified subgroups in SPRINT: age ≥75 years, prior cardiovascular disease, chronic kidney disease, women, black race, and 3 levels of baseline systolic BP (≤132 versus >132 to <145 versus ≥145 mm Hg).
ADHF was defined as hospitalization for ADHF, confirmed and formally adjudicated by a blinded events committee using standardized protocols. At 3.29 years follow-up, there were 103 ADHF events (2.2%) among 4683 standard arm participants and 65 ADHF events (1.4%) among 4678 intensive arm participants (Cox proportional hazards ratio, 0.63; 95% confidence interval, 0.46-0.85; value =0.003). In multivariable analyses, including treatment arm, baseline covariates that were significant predictors for ADHF included chronic kidney disease, cardiovascular disease, age≥75 years, body mass index, and higher systolic BP. The beneficial effect of the intervention on incident ADHF was consistent across all prespecified subgroups. Participants who had incident ADHF had markedly increased risk of subsequent cardiovascular events, including a 27-fold increase (<0.001) in cardiovascular death.
Targeting a systolic BP<120 mm Hg, compared with <140 mm Hg, significantly reduced ADHF events, and the benefit was similar across all key, prespecified subgroups. Participants who developed ADHF had markedly increased risk for subsequent cardiovascular events and death, highlighting the importance of strategies aimed at prevention of ADHF, especially intensive BP reduction.
URL: http://www.clinicaltrials.gov. Unique identifier: NCT01206062.
急性失代偿性心力衰竭（ADHF）是收缩压干预试验（SPRINT）中常见的一个频繁出现的结局。我们研究了在SPRINT预先设定的6个关键亚组中，强化血压治疗对ADHF事件的减少是否存在差异，这6个亚组分别为：年龄≥75岁、既往有心血管疾病、慢性肾脏病、女性、黑人种族以及3个基线收缩压水平（≤132mmHg与>132至<145mmHg与≥145mmHg）。
ADHF定义为因ADHF住院，由一个盲法事件委员会使用标准化方案进行确认和正式判定。在3.29年的随访中，4683名标准治疗组参与者中有103例ADHF事件（2.2%），4678名强化治疗组参与者中有65例ADHF事件（1.4%）（Cox比例风险比，0.63；95%置信区间，0.46 - 0.85；P值 = 0.003）。在多变量分析中，包括治疗组，对ADHF有显著预测作用的基线协变量包括慢性肾脏病、心血管疾病、年龄≥75岁、体重指数以及较高的收缩压。干预对新发ADHF的有益作用在所有预先设定的亚组中都是一致的。发生ADHF的参与者随后发生心血管事件的风险显著增加，包括心血管死亡增加27倍（P<0.001）。
将收缩压目标设定为<120mmHg，与<140mmHg相比，显著减少了ADHF事件，并且在所有关键的预先设定亚组中获益相似。发生ADHF的参与者随后发生心血管事件和死亡的风险显著增加，这突出了旨在预防ADHF策略的重要性，尤其是强化降压。
