Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA.
Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA
J Am Heart Assoc. 2018 Feb 23;7(5):e007475. doi: 10.1161/JAHA.117.007475.
Although diastolic blood pressure (DBP) is independently associated with an increased risk of adverse cardiovascular outcomes in the general population, it is unclear if a similar relationship exists in patients with heart failure with preserved ejection fraction.
This analysis included 1703 (mean age, 72±10 years; 50% men; 78% white) patients with heart failure with preserved ejection fraction enrolled in the TOPCAT (Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist) Trial from the Americas who were treated for hypertension. Multivariable Cox regression was used to examine the risk of hospitalization for heart failure, death, and cardiovascular death associated with DBP. The relationship between hospitalization for heart failure and DBP was linear, with an increased risk observed with decreasing DBP values (≥90 mm Hg: referent; 80-89 mm Hg: hazard ratio [HR], 1.44; 95% confidence interval [CI], 0.85-2.44; 70-79 mm Hg: HR, 1.18; 95% CI, 0.69-2.01; 60-69 mm Hg: HR, 1.54; 95% CI, 0.90-2.63; <60 mm Hg: HR, 2.12; 95% CI, 1.20-3.74; =0.0055 for trend). The associations of DBP with death (≥90 mm Hg: HR, 1.86; 95% CI, 1.12-3.06; 80-89 mm Hg: HR, 1.23; 95% CI, 0.89-1.70; 70-79 mm Hg: referent; 60-69 mm Hg: HR, 1.20; 95% CI, 0.90-1.59; <60 mm Hg: HR, 1.68; 95% CI, 1.21-2.33) and cardiovascular death (≥90 mm Hg: HR, 2.02; 95% CI, 1.10-3.71; 80-89 mm Hg: HR, 1.17; 95% CI, 0.77-1.79; 70-79 mm Hg: referent; 60-69 mm Hg: HR, 1.16; 95% CI, 0.80-1.70; <60 mm Hg: HR, 1.85; 95% CI, 1.21-2.82) were nonlinear, with a greater risk of each outcome observed with DBP values ≥90 and <60 mm Hg.
DBP values ≥90 and <60 mm Hg are associated with a significant risk of adverse outcomes in patients with heart failure with preserved ejection fraction who are treated for hypertension. Further research is needed to determine optimal DBP targets to reduce the risk of adverse events in patients with heart failure with preserved ejection fraction.
尽管舒张压（DBP）与一般人群中不良心血管结局的风险增加独立相关，但在射血分数保留的心力衰竭患者中是否存在类似的关系尚不清楚。
本分析纳入了 1703 名（平均年龄 72±10 岁；50%为男性；78%为白人）接受降压治疗的射血分数保留的心力衰竭患者，他们来自美洲的 TOPCAT（醛固酮拮抗剂治疗保留心脏功能的心力衰竭）试验。多变量 Cox 回归用于检查与 DBP 相关的心力衰竭住院、死亡和心血管死亡的风险。与 DBP 相关的心力衰竭住院呈线性关系，随着 DBP 值的降低（≥90mmHg：参考值；80-89mmHg：危险比[HR]，1.44；95%置信区间[CI]，0.85-2.44；70-79mmHg：HR，1.18；95%CI，0.69-2.01；60-69mmHg：HR，1.54；95%CI，0.90-2.63；<60mmHg：HR，2.12；95%CI，1.20-3.74；趋势=0.0055）观察到风险增加。DBP 与死亡（≥90mmHg：HR，1.86；95%CI，1.12-3.06；80-89mmHg：HR，1.23；95%CI，0.89-1.70；70-79mmHg：参考值；60-69mmHg：HR，1.20；95%CI，0.90-1.59；<60mmHg：HR，1.68；95%CI，1.21-2.33）和心血管死亡（≥90mmHg：HR，2.02；95%CI，1.10-3.71；80-89mmHg：HR，1.17；95%CI，0.77-1.79；70-79mmHg：参考值；60-69mmHg：HR，1.16；95%CI，0.80-1.70；<60mmHg：HR，1.85；95%CI，1.21-2.82）是非线性的，观察到每个结局的风险增加与 DBP 值≥90mmHg 和<60mmHg 相关。
DBP 值≥90mmHg 和<60mmHg 与接受降压治疗的射血分数保留的心力衰竭患者不良结局的显著风险相关。需要进一步研究以确定最佳的 DBP 目标，以降低射血分数保留的心力衰竭患者不良事件的风险。
