Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia (L.R.).
Department of Preventive Medicine (T.-H.T.V., N.S.S., M.R.C., M.D.H., D.M.L.-J., S.S.K.), Northwestern University Feinberg School of Medicine, Chicago, IL.
Circ Heart Fail. 2022 May;15(5):e009229. doi: 10.1161/CIRCHEARTFAILURE.121.009229. Epub 2022 Apr 28.
Multisociety guidelines recommend a goal systolic blood pressure (BP) <130 mm Hg and a hemoglobin A1c (HbA1c) <8% in patients with heart failure (HF), regardless of ejection fraction. Few studies have described BP and glycemic control in ambulatory patients with HF and racial and ethnic disparities in this subset of the population.
We evaluated prevalence of uncontrolled BP and HbA1c in non-Hispanic Black, non-Hispanic White, and Mexican American adults aged ≥20 years with self-reported HF (National Health and Nutrition Examination Surveys: 2001-2018). Prevalence ratios (95% CI) for uncontrolled BP and HbA1c were calculated by race and ethnicity and adjusted for sex, age, treatment, and socioeconomic status. In secondary analyses, we examined trends in the prevalence of uncontrolled BP and HbA1c.
Uncontrolled BP was present in 48% (95% CI, 49%-56%) of adults with HF (representing 2.3 million people). Non-Hispanic Black participants had a higher prevalence of uncontrolled BP compared with non-Hispanic White participants (53% [48%-58%] compared with 47% [43%-51%], <0.05). In adjusted models, non-Hispanic Black participants were 1.19 (1.02-1.39) times more likely to have uncontrolled BP than non-Hispanic White participants. Overall, uncontrolled HbA1c was found in 8% (6%, 10%) with no differences by race and ethnicity. Prevalence of uncontrolled BP improved over time but uncontrolled risk factors remained high-2017 to 2018: 41% (36%, 47%) and 7% (5%, 12%) had uncontrolled BP and HbA1c, respectively.
We document an unacceptably high prevalence of uncontrolled BP and HbA1c in a nationally representative, ambulatory HF sample with significant differences in BP control by race and ethnicity.
多学会指南建议心力衰竭（HF）患者的目标收缩压（BP）<130mmHg 和血红蛋白 A1c（HbA1c）<8%，无论射血分数如何。很少有研究描述过 HF 门诊患者的 BP 和血糖控制情况，以及该人群中种族和民族差异。
我们评估了报告有 HF 的非西班牙裔黑人、非西班牙裔白人和墨西哥裔美国成年人中，年龄≥20 岁的患者中血压和糖化血红蛋白控制不佳的发生率（国家健康和营养调查：2001-2018 年）。按种族和民族计算血压和糖化血红蛋白控制不佳的患病率比（95%CI），并按性别、年龄、治疗和社会经济状况进行调整。在次要分析中，我们检查了血压和糖化血红蛋白控制不佳的患病率趋势。
HF 患者中血压控制不佳的比例为 48%（95%CI，49%-56%）（代表 230 万人）。与非西班牙裔白人患者相比，非西班牙裔黑人患者血压控制不佳的比例更高（53%[48%-58%]比 47%[43%-51%]，<0.05）。在调整后的模型中，非西班牙裔黑人患者发生血压控制不佳的可能性是非西班牙裔白人患者的 1.19 倍（1.02-1.39）。总体而言，种族和民族之间没有差异，糖化血红蛋白控制不佳的比例为 8%（6%，10%）。
我们在一个具有代表性的、门诊 HF 样本中发现，血压和糖化血红蛋白控制不佳的比例高得令人无法接受，而且种族和民族之间在血压控制方面存在显著差异。
