Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina.
Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland.
Am J Cardiol. 2022 Feb 15;165:58-64. doi: 10.1016/j.amjcard.2021.10.049. Epub 2021 Dec 11.
Given the concern that beta-blocker use may be associated with an increased risk for heart failure (HF) in populations with normal left ventricular systolic function, we evaluated the association between beta-blocker use and incident HF events, as well as loop diuretic initiation in the Systolic Blood Pressure Intervention Trial (SPRINT). SPRINT demonstrated that a blood pressure target of <120 mm Hg reduced cardiovascular outcomes compared with <140 mm Hg in adults with at least one cardiovascular risk factor and without HF. The lower rate of the composite primary outcome in the 120 mm Hg group was primarily driven by a reduction in HF events. Subjects on a beta blocker for the entire trial duration were compared with subjects who never received a beta blocker after 1:1 propensity score matching. A competing risk survival analysis by beta-blocker status was performed to estimate the effect of the drug on incident HF and was then repeated for a secondary end point of cardiovascular disease death. Among the 3,284 propensity score-matched subjects, beta-blocker exposure was associated with an increased HF risk (hazard ratio 5.86; 95% confidence interval 2.73 to 13.04; p <0.001). A sensitivity analysis of propensity score-matched cohorts with a history of coronary artery disease or atrial fibrillation revealed the same association (hazard ratio 3.49; 95% confidence interval 1.15 to 10.06; p = 0.028). In conclusion, beta-blocker exposure in this secondary analysis was associated with increased incident HF in subjects with hypertension without HF at baseline.
鉴于β受体阻滞剂的使用可能与左心室收缩功能正常人群中心力衰竭（HF）风险增加有关，我们评估了β受体阻滞剂的使用与事件性 HF 以及噻嗪类利尿剂起始治疗之间的相关性，这项研究是在收缩压干预试验（SPRINT）中进行的。SPRINT 表明，与收缩压<140mmHg 相比，血压目标值<120mmHg 可降低心血管结局风险，试验纳入了至少有 1 个心血管风险因素且无 HF 的成年人。120mmHg 组复合主要终点的发生率较低，主要是由于 HF 事件减少。对整个试验期间持续使用β受体阻滞剂的患者与从未接受过β受体阻滞剂的患者进行了 1:1 的倾向评分匹配，然后按β受体阻滞剂状态进行竞争风险生存分析，以评估该药物对新发 HF 的影响，并重复进行心血管疾病死亡的次要终点分析。在 3284 名倾向评分匹配的患者中，β受体阻滞剂的使用与 HF 风险增加相关（风险比 5.86；95%置信区间 2.73 至 13.04；p<0.001）。对有冠心病或心房颤动病史的倾向评分匹配队列进行敏感性分析，也发现了同样的关联（风险比 3.49；95%置信区间 1.15 至 10.06；p=0.028）。总之，在这项二级分析中，在基线时无 HF 的高血压患者中，β受体阻滞剂的暴露与新发 HF 风险增加相关。
