Department of Cardiovascular Medicine, Minaminagano Medical Center, Shinonoi General Hospital, Ai 666-1 Shinonoi, Nagano, 388-8004, Japan.
Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Japan.
Heart Vessels. 2021 Aug;36(8):1159-1165. doi: 10.1007/s00380-021-01788-0. Epub 2021 Feb 2.
Although systolic blood pressure (SBP) is routinely considered when treating acute heart failure (HF), diastolic blood pressure (DBP) is hardly been assessed in the situation. There are no previous studies regarding the predictive value of DBP in elderly patients with HF with preserved ejection fraction (HFpEF) in Japan. This study aimed to investigate the prognostic significance of DBP in patients with acute decompensated HFpEF. We analyzed data of all HFpEF patients admitted to Shinonoi General Hospital for HF treatment between July 2016 and December 2018. We excluded patients with acute coronary syndrome and severe valvular disease. Patients were divided into two groups according to their median DBP; the low DBP group (DBP ≤ 77 mmHg, n = 106) and the high DBP group (DBP > 77 mmHg, n = 100). The primary outcome was HF readmission. In 206 enrolled patients (median 86 years), during a median follow-up of 302 days, the primary outcome occurred in 48 patients. The incidence of HF readmission was significantly higher in the low DBP group (33.0% vs 18.5%, p = 0.024). In Kaplan-Meier analysis, low DBP predicted HF readmission (Log-rank test, p = 0.013). In Cox proportional hazard analysis, low DBP was an independent predictor of HF readmission after adjustment for age, sex, SBP, hemoglobin, serum albumin, serum creatinine, B-type natriuretic peptide, renin-angiotensin system inhibitors, calcium channel blockers, left ventricular ejection fraction, coronary artery disease, and whether they live alone (hazard ratio, 2.229; 95% confidence interval, 1.021-4.867; p = 0.044). Low DBP predicted HF readmission in patients with HFpEF.
虽然在治疗急性心力衰竭（HF）时通常会考虑收缩压（SBP），但在这种情况下舒张压（DBP）几乎没有得到评估。在日本，以前没有研究过 DBP 在射血分数保留的心力衰竭（HFpEF）老年患者中的预测价值。本研究旨在探讨 DBP 在急性失代偿性 HFpEF 患者中的预后意义。我们分析了 2016 年 7 月至 2018 年 12 月期间因 HF 入住 Shinonoi 综合医院的所有 HFpEF 患者的数据。我们排除了急性冠状动脉综合征和严重瓣膜病患者。根据 DBP 的中位数，将患者分为两组；低 DBP 组（DBP≤77mmHg，n=106）和高 DBP 组（DBP＞77mmHg，n=100）。主要结局是 HF 再入院。在 206 名入组患者（中位数 86 岁）中，中位随访 302 天期间，48 名患者发生了主要结局。低 DBP 组 HF 再入院的发生率明显更高（33.0%比 18.5%，p=0.024）。在 Kaplan-Meier 分析中，低 DBP 预测 HF 再入院（对数秩检验，p=0.013）。在 Cox 比例风险分析中，在校正年龄、性别、SBP、血红蛋白、血清白蛋白、血清肌酐、B 型利钠肽、肾素-血管紧张素系统抑制剂、钙通道阻滞剂、左心室射血分数、冠心病和是否独居后，低 DBP 是 HF 再入院的独立预测因素（风险比，2.229；95%置信区间，1.021-4.867；p=0.044）。低 DBP 预测 HFpEF 患者的 HF 再入院。
