急性心力衰竭住院治疗期间血压下降：4 项随机对照试验的患者水平分析。
Blood Pressure Drops During Hospitalization for Acute Heart Failure Treated With Serelaxin: A Patient-Level Analysis of 4 Randomized Controlled Trials.
机构信息
Department of Cardiology Bispebjerg Hospital (J.G., K.M., A.S., O.W.N.), University of Copenhagen, Denmark.
Department of Cardiology, Rigshospitalet (L.K.), University of Copenhagen, Denmark.
出版信息
Circ Heart Fail. 2022 Apr;15(4):e009199. doi: 10.1161/CIRCHEARTFAILURE.121.009199. Epub 2022 Feb 21.
BACKGROUND
Hypotensive events and drops in systolic blood pressure (SBP-drop) are frequent in patients hospitalized with acute heart failure. We investigated whether SBP-drops are associated with outcomes in patients treated with serelaxin.
METHODS
Patient-level retrospective analyses of 4 prospective trials investigating serelaxin in acute heart failure. Main inclusion criteria were SBP 125 to 180 mm Hg, pulmonary congestion, and elevated NT-proBNP (N-terminal pro-B-type natriuretic peptide). SBP-drops were prospectively defined as SBP<100 mm Hg, or, if SBP remained >100 mm Hg, a drop from baseline of 40 mm Hg from baseline. Outcomes were a short-term composite outcome (worsening heart failure, hospital readmission for heart failure or all-cause mortality through 14 days) and 180-day mortality.
RESULTS
Overall, 2559/11 226 (23%) patients had an SBP-drop. SBP-drop, versus no SBP-drop, was associated with a worse outcome: cumulative incidence of 180-day mortality (11% versus 9%, hazard ratio [HR]. 1.21 [95% CI, 1.05-1.39]; =0.009) and the short-term outcome (11% versus 9%, HR, 1.29 [95% CI, 1.13-1.49]; <0.001). Of the 2 SBP-drop components, an SBP<100 mm Hg was associated with the worst outcome compared with a 40 mm Hg drop: short-term outcome (11% versus 10%) and HRs of 1.32 (95% CI, 1.13-1.55; =0.0005) and 1.22 (95% CI, 0.97-1.56; =0.09), for each component respectively, with a value for interaction of 0.05. SBP-drops were associated with a worse short-term outcome in the placebo group (HR, 1.46 [95% CI, 1.19-1.79]; =0.0003), but not in the serelaxin-group (HR, 1.18 [95% CI, 0.97-1.42]; =0.10); interaction=0.003.
CONCLUSIONS
SBP-drops in patients with acute heart failure and normal to high SBP at admission is associated with worse short- and long-term outcomes especially for SBP <100 mm Hg. However, in patients treated with the intravenous vasodilator serelaxin, SBP-drops seemed less harmful.
REGISTRATION
URL: https://www.
CLINICALTRIALS
gov; Unique identifiers: NCT02064868, NCT02007720, NCT01870778, NCT00520806.
背景
在因急性心力衰竭住院的患者中，低血压事件和收缩压下降（SBP 下降）很常见。我们研究了 SBP 下降是否与接受雷泌素治疗的患者的结局相关。
方法
对 4 项雷泌素治疗急性心力衰竭的前瞻性试验进行患者水平的回顾性分析。主要纳入标准为收缩压 125 至 180mmHg、肺充血和升高的 NT-proBNP（氨基末端 B 型利钠肽前体）。SBP 下降被前瞻性定义为 SBP<100mmHg，或者，如果 SBP 仍>100mmHg，则与基线相比下降 40mmHg。结局为短期复合结局（心力衰竭恶化、心力衰竭再次住院或 14 天内全因死亡率）和 180 天死亡率。
结果
总体而言，2559/11226（23%）名患者出现 SBP 下降。与无 SBP 下降相比，SBP 下降与更差的结局相关：180 天死亡率的累积发生率（11% vs 9%，风险比 [HR] 1.21[95%CI，1.05-1.39]；=0.009）和短期结局（11% vs 9%，HR 1.29[95%CI，1.13-1.49]；<0.001）。在 2 个 SBP 下降组成部分中，SBP<100mmHg 与最差结局相关，与 40mmHg 下降相比：短期结局（11% vs 10%）和 HRs 分别为 1.32（95%CI，1.13-1.55；=0.0005）和 1.22（95%CI，0.97-1.56；=0.09），每个组成部分的 P 值为 0.05。SBP 下降与安慰剂组短期结局恶化相关（HR 1.46[95%CI，1.19-1.79]；=0.0003），但在雷泌素组中则无此关联（HR 1.18[95%CI，0.97-1.42]；=0.10）；交互作用 P 值为 0.003。
结论
在入院时收缩压正常至偏高的急性心力衰竭患者中，SBP 下降与短期和长期结局恶化相关，特别是 SBP<100mmHg 时。然而，在接受静脉血管扩张剂雷泌素治疗的患者中，SBP 下降似乎危害较小。
登记
临床试验
NCT02064868、NCT02007720、NCT01870778、NCT00520806。
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