Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea.
JACC Heart Fail. 2017 Nov;5(11):810-819. doi: 10.1016/j.jchf.2017.08.015.
This study aimed to assess the relationship between on-treatment blood pressure (BP) and clinical outcomes of patients with heart failure (HF).
Lower BP has been reported to be related to increased mortality in various cardiovascular diseases. The optimal BP level for patients already experiencing HF is contentious.
The Korean Acute Heart Failure registry prospectively enrolled a total of 5,625 consecutive patients hospitalized for acute HF in 10 tertiary university hospitals in Korea between March 2011 and February 2014. Clinical profiles including BP were collected at admission, discharge, and during outpatient follow-up. Mean on-treatment BP was calculated from BP at discharge and at each follow-up visit. We evaluated the effects of mean on-treatment BP on the clinical outcomes of patients.
Patients were followed up for a median 2.2 years. One-year mortality after discharge was 18.2%. The relationship between on-treatment BP and all-cause mortality followed a reversed J-curve relationship. A nonlinear, multivariable Cox proportional hazard model identified a nadir of systolic and diastolic BPs of 132.4/74.2 mm Hg in patients, for whom the mortality rate was lowest (p < 0.0001). The relationship with increased mortality above and below the reference BP was more definitive for diastolic BP and for HF with a preserved ejection fraction.
Systolic and diastolic BPs <130/70 mm Hg at discharge and during follow-up was associated with worse survival in HF patients. These data suggest that the lowest BP possible might not be an optimal target for HF patients. Further studies should establish a proper BP goal in HF patients. (Registry [Prospective Cohort] for Heart Failure in Korea [KorAHF]; NCT01389843).
本研究旨在评估治疗期间血压（BP）与心力衰竭（HF）患者临床结局之间的关系。
已有研究报道，在各种心血管疾病中，较低的血压与死亡率增加相关。对于已经患有 HF 的患者，最佳的 BP 水平存在争议。
韩国急性心力衰竭注册研究前瞻性纳入了 2011 年 3 月至 2014 年 2 月期间在韩国 10 家三级大学医院因急性 HF 住院的共 5625 例连续患者。在入院、出院和门诊随访期间收集包括 BP 在内的临床特征。从出院时和每次随访时的 BP 计算治疗期间的平均 BP。我们评估了平均治疗期间 BP 对患者临床结局的影响。
患者的中位随访时间为 2.2 年。出院后 1 年的死亡率为 18.2%。治疗期间 BP 与全因死亡率之间呈反向 J 型关系。非线性多变量 Cox 比例风险模型确定了收缩压和舒张压的最低点分别为 132.4/74.2mmHg，死亡率最低（p<0.0001）。对于舒张压和射血分数保留的 HF，高于和低于参考 BP 的死亡率增加与死亡率之间的关系更为明确。
HF 患者出院时和随访期间的收缩压和舒张压<130/70mmHg 与生存状况较差相关。这些数据表明，HF 患者可能不可能将 BP 降至最低作为最佳目标。进一步的研究应确定 HF 患者的适当 BP 目标。（韩国心力衰竭注册研究[KorAHF]；NCT01389843）。
