Cardiovascular Medicine Section (B.U., D.W.K.), Wake Forest School of Medicine, Winston-Salem, NC.
Biostatistics (J.J.W., L.C.L.), Wake Forest School of Medicine, Winston-Salem, NC.
Circ Heart Fail. 2021 Dec;14(12):e008322. doi: 10.1161/CIRCHEARTFAILURE.121.008322. Epub 2021 Nov 26.
In the SPRINT (Systolic Blood Pressure Intervention Trial), intensive BP treatment reduced acute decompensated heart failure (ADHF) events. Here, we report the effect on HF with preserved ejection fraction (HFpEF) and HF with reduced EF (HFrEF) and their subsequent outcomes.
Incident ADHF was defined as hospitalization or emergency department visit, confirmed, and formally adjudicated by a blinded events committee using standardized protocols. HFpEF was defined as EF ≥45%, and HFrEF was EF <45%.
Among the 133 participants with incident ADHF who had EF assessment, 69 (52%) had HFpEF and 64 (48%) had HFrEF ( value: 0.73). During average 3.3 years follow-up in those who developed incident ADHF, rates of subsequent all-cause and HF hospital readmission and mortality were high, but there were no significant differences between those who developed HFpEF versus HFrEF. Randomization to the intensive arm had no effect on subsequent mortality or readmissions after the initial ADHF event, irrespective of EF subtype. During follow-up among participants who developed HFpEF, although relatively modest number of events limited statistical power, age was an independent predictor of all-cause mortality, and Black race independently predicted all-cause and HF hospital readmission.
In SPRINT, intensive BP reduction decreased both acute decompensated HFpEF and HFrEF events. After initial incident ADHF, rates of subsequent hospital admission and mortality were high and were similar for those who developed HFpEF or HFrEF. Randomization to the intensive arm did not alter the risks for subsequent all-cause, or HF events in either HFpEF or HFrEF. Among those who developed HFpEF, age and Black race were independent predictors of clinical outcomes. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT01206062.
在 SPRINT（收缩压干预试验）中，强化血压治疗降低了急性失代偿性心力衰竭（ADHF）事件的发生。在此，我们报告对射血分数保留的心力衰竭（HFpEF）和射血分数降低的心力衰竭（HFrEF）的影响及其随后的结果。
新发 ADHF 定义为住院或急诊就诊，经盲法事件委员会使用标准化方案确认和正式裁决。HFpEF 的定义为 EF≥45%，HFrEF 的定义为 EF<45%。
在 133 名新发 ADHF 患者中，有 EF 评估的患者有 69 名（52%）患有 HFpEF，64 名（48%）患有 HFrEF（ 值：0.73）。在新发 ADHF 患者平均 3.3 年的随访期间，全因和 HF 再入院和死亡率均很高，但 HFpEF 与 HFrEF 之间无显著差异。无论 EF 亚型如何，随机分配到强化组对初始 ADHF 事件后的死亡率或再入院均无影响。在新发 HFpEF 的患者随访期间，尽管事件数量相对较少，限制了统计效力，但年龄是全因死亡率的独立预测因素，黑种人独立预测全因和 HF 住院再入院。
在 SPRINT 中，强化血压降低减少了急性失代偿性 HFpEF 和 HFrEF 事件。在初始新发 ADHF 后，随后的住院和死亡率较高，HFpEF 或 HFrEF 患者的情况相似。强化组的随机分组并未改变 HFpEF 或 HFrEF 患者的全因或 HF 事件的风险。在新发 HFpEF 的患者中，年龄和黑种人是临床结局的独立预测因素。
