根据血压的不同，射血分数降低的慢性心力衰竭患者的治疗差异。
Treatment Differences in Chronic Heart Failure Patients With Reduced Ejection Fraction According to Blood Pressure.
机构信息
Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Thorax Center, Rotterdam, the Netherlands (J.F.V., J.J.B.).
Department of Cardiology, Maastricht University Medical Center, Maastricht, the Netherlands (H.-P.B.-L.R.).
出版信息
Circ Heart Fail. 2020 May;13(5):e006667. doi: 10.1161/CIRCHEARTFAILURE.119.006667. Epub 2020 May 6.
BACKGROUND
Prescribed dosages of heart failure (HF) therapy in patients with a reduced left ventricular ejection fraction remain lower than guideline recommended. It remains unclear whether systolic blood pressure (BP) influences prescription of HF drugs to HF patients with a reduced left ventricular ejection fraction in a European setting. This study aimed to investigate the role of systolic BP on the prescription rate and actual dose of guideline-recommended HF therapy.
METHODS
A total of 8246 patients with chronic HF with a reduced left ventricular ejection fraction from 34 Dutch outpatient HF clinics were included. Detailed information on prescription rates and dosages of HF drugs were assessed according to systolic BP categories (<95, 95-109, 110-129, and ≥130 mm Hg).
RESULTS
Patients with systolic BP <95 mm Hg receive more often triple therapy (β-blocker, renin-angiotensin system inhibitor, and mineralocorticoid receptor antagonist; 40.3% versus 30.4% respectively, <0.001) compared with ≥130 mm Hg. Patients with systolic BP <95 mm Hg received significantly more often mineralocorticoid receptor antagonists (64.5% versus 43.8%), ivabradine (8.3% versus 3.6%), and diuretics (94.2% versus 78.6%) and less often renin-angiotensin system inhibitors (75.4% versus 82.8%) compared with ≥130 mm Hg ( for all trends, <0.001). The prescribed dosages of β-blockers and renin-angiotensin system inhibitors were significantly lower in patients with systolic BP <95 mm Hg compared with ≥130 mm Hg ( for all trends, <0.001).
CONCLUSIONS
In this large cross-sectional cohort of patients with reduced left ventricular ejection fraction, patients with lower systolic BP receive more HF drugs but at lower dose relative to the target dose recommended in HF guidelines. Discussion is warranted regarding what target BP is acceptable and what should be limiting factors in uptitration to adequate levels of HF medication.
背景
心力衰竭（HF）治疗的规定剂量在射血分数降低的患者中仍低于指南推荐的剂量。在欧洲环境下，收缩压（BP）是否会影响射血分数降低的 HF 患者 HF 药物的处方仍不清楚。本研究旨在探讨收缩压在 HF 治疗指南推荐的 HF 药物处方率和实际剂量中的作用。
方法
共纳入 34 家荷兰门诊 HF 诊所的 8246 例慢性射血分数降低的 HF 患者。根据收缩压类别（<95、95-109、110-129 和 ≥130mmHg）评估 HF 药物的处方率和剂量。
结果
收缩压<95mmHg 的患者比收缩压≥130mmHg 的患者更常接受三联疗法（β受体阻滞剂、肾素-血管紧张素系统抑制剂和盐皮质激素受体拮抗剂；分别为 40.3%和 30.4%，<0.001）。收缩压<95mmHg 的患者更常接受盐皮质激素受体拮抗剂（64.5%比 43.8%）、伊伐布雷定（8.3%比 3.6%）和利尿剂（94.2%比 78.6%），而较少接受肾素-血管紧张素系统抑制剂（75.4%比 82.8%），与收缩压≥130mmHg 相比（所有趋势，<0.001）。收缩压<95mmHg 的患者β受体阻滞剂和肾素-血管紧张素系统抑制剂的处方剂量明显低于收缩压≥130mmHg 的患者（所有趋势，<0.001）。
结论
在射血分数降低的患者的这项大型横断面队列研究中，收缩压较低的患者接受了更多的 HF 药物，但与 HF 指南推荐的目标剂量相比，剂量较低。需要讨论什么目标 BP 是可以接受的，以及在 HF 药物剂量上调到适当水平时，什么应该是限制因素。
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