Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
Department of Cardiology, Osaka Medical and Pharmaceutical University, Takatsuki, Japan.
Sci Rep. 2022 Feb 18;12(1):2802. doi: 10.1038/s41598-022-06760-0.
Although postural hypotension (PH) is reportedly associated with mortality in the general population, the prognostic value for heart failure is unclear. This was a post-hoc analysis of FRAGILE-HF, a prospective multicenter observational study focusing on frailty in elderly patients with heart failure. Overall, 730 patients aged ≥ 65 years who were hospitalized with heart failure were enrolled. PH was defined by evaluating seated PH, and was defined as a fall of ≥ 20 mmHg in systolic and/or ≥ 10 mmHg in diastolic blood pressure within 3 min after transition from a supine to sitting position. The study endpoints were all-cause death and heart failure readmission at 1 year. Predictive variables for the presence of PH were also evaluated. PH was observed in 160 patients (21.9%). Patients with PH were more likely than those without PH to be male with a New York Heart Association classification of III/IV. Logistic regression analysis showed that male sex, severe heart failure symptoms, and lack of administration of angiotensin-converting enzyme inhibitors were independently associated with PH. PH was not associated with 1-year mortality, but was associated with a lower incidence of readmission after discharge after adjustment for other covariates. In conclusion, PH was associated with reduced risk of heart failure readmission but not with 1-year mortality in older patients with heart failure.
虽然体位性低血压（PH）据报道与普通人群的死亡率有关，但对心力衰竭的预后价值尚不清楚。这是 FRAGILE-HF 的事后分析，FRAGILE-HF 是一项针对老年心力衰竭患者衰弱的前瞻性多中心观察性研究。总体而言，共纳入了 730 名年龄≥65 岁的因心力衰竭住院的患者。通过评估坐姿 PH 来定义 PH，定义为从仰卧位转变为坐姿后 3 分钟内收缩压下降≥20mmHg 和/或舒张压下降≥10mmHg。研究终点为 1 年时的全因死亡和心力衰竭再入院。还评估了预测 PH 存在的变量。160 名患者（21.9%）出现 PH。与无 PH 患者相比，PH 患者更可能为男性，纽约心脏协会（NYHA）分级为 III/IV 级。Logistic 回归分析显示，男性、严重心力衰竭症状和未使用血管紧张素转换酶抑制剂与 PH 独立相关。PH 与 1 年死亡率无关，但与调整其他协变量后出院后的心力衰竭再入院发生率降低有关。总之，在老年心力衰竭患者中，PH 与心力衰竭再入院风险降低相关，但与 1 年死亡率无关。
