Darling Chad E, Sun Jiaoyuan Elisabeth, Goldberg Jordan, Pang Peter, Baugh Christopher W, Lessard Darleen, McManus David D
Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, MA, USA.
Department of Emergency Medicine, University of Indiana, Indianapolis, IN, USA.
J Cardiovasc Dis Diagn. 2017 May;5(3). doi: 10.4172/2329-9517.1000275. Epub 2017 May 15.
The initial systolic blood pressure (SBP) in patients presenting to the hospital with acute heart failure (AHF) informs prognosis, diagnosis, and guides initial treatment. However, over time AHF presentations with elevated SBP appear to have declined. The present study examined whether the frequency of AHF presentations with systolic hypertension (SBP >160 mmHg) declined over a nearly two-decade time interval.
This study compares four historical, cross-sectional cohorts with AHF who were admitted to tertiary care medical centres in the North-eastern USA in 1995, 2000, 2006, and 2011-13. The main outcome was the proportion of AHF patients presenting with an initial SBP >160 mmHg.
2,366 patients comprised the study sample. The average age was 77 years, 55% were female, 94% white, and 75% had prior heart failure. In 1995, 34% of AHF patients presented with an initial SBP >160 mmHg compared to 20% in 2011-2013 (p<0.01). Multivariate logistic regression demonstrated reduced odds of presenting with a SBP >160 mmHg in 2006 (0.64, 95% CI 0.42-0.96) and 2011-13 (0.46, 95% CI 0.28-0.74) compared with patients in 1995.
The proportion of patients with AHF and initial SBP >160 mmHg significantly declined over the study time period. There are several potential reasons for this observation and these findings highlight the need for ongoing surveillance of patients with AHF as changing clinical characteristics can impact early treatment decisions.
因急性心力衰竭（AHF）入院患者的初始收缩压（SBP）对预后、诊断及初始治疗具有指导意义。然而，随着时间推移，初始SBP升高的AHF病例数似乎有所下降。本研究旨在探讨在近二十年时间里，收缩期高血压（SBP>160 mmHg）的AHF病例出现频率是否下降。
本研究比较了1995年、2000年、2006年以及2011 - 2013年在美国东北部三级医疗中心收治的四组AHF历史横断面队列。主要观察指标为初始SBP>160 mmHg的AHF患者比例。
2366例患者纳入研究样本。平均年龄77岁，55%为女性，94%为白人，75%既往有心力衰竭病史。1995年，34%的AHF患者初始SBP>160 mmHg，而2011 - 2013年这一比例为20%（p<0.01）。多因素logistic回归分析显示，与1995年患者相比，2006年（0.64，95%CI 0.42 - 0.96）及2011 - 2013年（0.46，95%CI 0.28 - 0.74）初始SBP>160 mmHg的患者比例降低。
在研究期间，初始SBP>160 mmHg的AHF患者比例显著下降。这一现象存在多种潜在原因，这些发现凸显了对AHF患者持续监测的必要性，因为临床特征的变化可能影响早期治疗决策。
