Veterans Affairs Medical Center, Washington, DC.
Georgetown University, Washington, DC.
JAMA Cardiol. 2018 Apr 1;3(4):288-297. doi: 10.1001/jamacardio.2017.5365.
Lower systolic blood pressure (SBP) levels are associated with poor outcomes in patients with heart failure. Less is known about this association in heart failure with preserved ejection fraction (HFpEF).
To determine the associations of SBP levels with mortality and other outcomes in HFpEF.
DESIGN, SETTING, AND PARTICIPANTS: A propensity score-matched observational study of the Medicare-linked Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure (OPTIMIZE-HF) registry included 25 354 patients who were discharged alive; 8873 (35.0%) had an ejection fraction of at least 50%, and of these, 3915 (44.1%) had stable SBP levels (≤20 mm Hg admission to discharge variation). Data were collected from 259 hospitals in 48 states between March 1, 2003, and December 31, 2004. Data were analyzed from March 1, 2003, to December 31, 2008.
Discharge SBP levels less than 120 mm Hg. A total of 1076 of 3915 (27.5%) had SBP levels less than 120 mm Hg, of whom 901 (83.7%) were matched by propensity scores with 901 patients with SBP levels of 120 mm Hg or greater who were balanced on 58 baseline characteristics.
Thirty-day, 1-year, and overall all-cause mortality and heart failure readmission through December 31, 2008.
The 1802 matched patients had a mean (SD) age of 79 (10) years; 1147 (63.7%) were women, and 134 (7.4%) were African American. Thirty-day all-cause mortality occurred in 91 (10%) and 45 (5%) of matched patients with discharge SBP of less than 120 mm Hg vs 120 mm Hg or greater, respectively (hazard ratio [HR], 2.07; 95% CI, 1.45-2.95; P < .001). Systolic blood pressure level less than 120 mm Hg was also associated with a higher risk of mortality at 1 year (39% vs 31%; HR, 1.36; 95% CI, 1.16-1.59; P < .001) and during a median follow-up of 2.1 (overall 6) years (HR, 1.17; 95% CI, 1.05-1.30; P = .005). Systolic blood pressure level less than 120 mm Hg was associated with a higher risk of heart failure readmission at 30 days (HR, 1.47; 95% CI, 1.08-2.01; P = .02) but not at 1 or 6 years. Hazard ratios for the combined end point of heart failure readmission or all-cause mortality associated with SBP level less than 120 mm at 30 days, 1 year, and overall were 1.71 (95% CI, 1.34-2.18; P < .001), 1.21 (95% CI, 1.07-1.38; P = .004), and 1.12 (95% CI, 1.01-1.24; P = .03), respectively.
Among hospitalized patients with HFpEF, an SBP level less than 120 mm Hg is significantly associated with poor outcomes. Future studies need to prospectively evaluate optimal SBP treatment goals in patients with HFpEF.
较低的收缩压（SBP）水平与心力衰竭患者的预后不良相关。在射血分数保留的心力衰竭（HFpEF）中，人们对这种关联的了解较少。
确定 SBP 水平与 HFpEF 患者死亡率和其他结局的关系。
设计、地点和参与者：一项基于医疗保险相关的有组织计划的倾向性评分匹配观察性研究，旨在启动住院心力衰竭患者的救生治疗（OPTIMIZE-HF）登记处包括 25354 名存活出院的患者；其中 8873 名（35.0%）射血分数至少为 50%，其中 3915 名（44.1%）SBP 水平稳定（入院至出院变化≤20mmHg）。数据来自 48 个州的 259 家医院，收集时间为 2003 年 3 月 1 日至 2004 年 12 月 31 日。数据分析时间为 2003 年 3 月 1 日至 2008 年 12 月 31 日。
出院时 SBP 水平低于 120mmHg。3915 名患者中共有 1076 名（27.5%）SBP 水平低于 120mmHg，其中 901 名（83.7%）通过倾向评分与 901 名 SBP 水平为 120mmHg 或更高的患者相匹配，这 901 名患者在 58 项基线特征上平衡。
30 天、1 年和总全因死亡率和心力衰竭再入院，直至 2008 年 12 月 31 日。
1802 名匹配患者的平均（SD）年龄为 79（10）岁；1147 名（63.7%）为女性，134 名（7.4%）为非裔美国人。30 天全因死亡率分别发生在出院 SBP 低于 120mmHg 和 120mmHg 或更高的匹配患者中，分别为 91 名（10%）和 45 名（5%）（风险比[HR]，2.07；95%置信区间[CI]，1.45-2.95；P<0.001）。SBP 水平低于 120mmHg 也与 1 年时死亡率风险增加相关（39% vs 31%；HR，1.36；95%CI，1.16-1.59；P<0.001）和中位随访时间为 2.1 年（总体 6 年）（HR，1.17；95%CI，1.05-1.30；P=0.005）。SBP 水平低于 120mmHg 与 30 天心力衰竭再入院风险增加相关（HR，1.47；95%CI，1.08-2.01；P=0.02），但与 1 年或 6 年无关。与 SBP 水平低于 120mmHg 相关的心力衰竭再入院或全因死亡率的 30 天、1 年和总体综合终点的危险比分别为 1.71（95%CI，1.34-2.18；P<0.001）、1.21（95%CI，1.07-1.38；P=0.004）和 1.12（95%CI，1.01-1.24；P=0.03）。
在 HFpEF 住院患者中，SBP 水平低于 120mmHg 与不良预后显著相关。未来的研究需要前瞻性评估 HFpEF 患者的最佳 SBP 治疗目标。
