Department of Medicine III, Saarland University Hospital, Homburg, Germany; Department of Medicine I, University of Würzburg, Würzburg, Germany; Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, New York.
Women's Health Initiative, Seattle, Washington.
Am J Prev Med. 2022 Sep;63(3):410-418. doi: 10.1016/j.amepre.2022.03.007. Epub 2022 May 4.
Little is known about the relationships between annual visit-to-visit blood pressure variability and heart failure subphenotypes. The aim of this analysis was to examine the association between blood pressure variability and incident heart failure with preserved and reduced ejection fraction.
Data from 23,918 postmenopausal women enrolled in the Women's Health Initiative Hormone Therapy Trials were analyzed. Blood pressure was measured at baseline (1993‒1998) and then annually through 2005. Variability was defined as the SD of the mean blood pressure across visits or the SD of the participant's regression line for blood pressure across visits. The outcome was the first heart failure hospitalization. Heart failure ascertainment and adjudications were through March 31, 2018.
During a mean follow-up of 15.8 years, 913 incident cases of heart failure with preserved ejection fraction and 421 cases of heart failure with reduced ejection fraction were identified. In fully adjusted models, including mean longitudinal systolic and diastolic blood pressure and time-varying coronary events interim to heart failure hospitalization, women in the highest versus in the lowest quartile of SD of the mean systolic blood pressure were at a statistically significantly higher risk of heart failure with preserved ejection fraction (hazard ratio [95% CI]=1.61 [1.12, 2.31]) but not of heart failure with reduced ejection fraction (1.18 [0.70,1.96]). Conversely, the hazard ratio (95% CI) for the highest versus lowest quartile of SD of the mean diastolic blood pressure was 1.56 (0.89, 2.74) for heart failure with reduced ejection fraction and 1.19 (0.85,1.65) for heart failure with preserved ejection fraction. Results attenuated for SD of the participant's regression line when additionally adjusted for the temporal trend of systolic and diastolic blood pressure.
Greater systolic blood pressure variability was associated with a higher risk of heart failure with preserved ejection fraction independent of mean blood pressure and coronary events interim to heart failure hospitalization.
关于年度就诊间血压变异性与心力衰竭亚型之间的关系知之甚少。本分析的目的是研究血压变异性与射血分数保留和降低的心力衰竭事件之间的相关性。
分析了参加妇女健康倡议激素治疗试验的 23918 名绝经后妇女的数据。血压在基线（1993-1998 年）测量，然后每年通过 2005 年进行测量。变异性定义为就诊间平均血压的标准差或就诊间血压参与者回归线的标准差。结果是首次心力衰竭住院。通过 2018 年 3 月 31 日确定心力衰竭的发生和判决。
在平均 15.8 年的随访中，确定了 913 例射血分数保留型心力衰竭和 421 例射血分数降低型心力衰竭的事件。在包括平均纵向收缩压和舒张压以及心力衰竭住院前的时间变化性冠状动脉事件的完全调整模型中，与最低四分位组相比，平均收缩压标准差最高的女性发生射血分数保留型心力衰竭的风险显著更高（风险比[95%置信区间]=1.61[1.12,2.31]），但射血分数降低型心力衰竭的风险比（95%置信区间）为 1.18[0.70,1.96]）。相反，最高四分位组与最低四分位组之间平均舒张压标准差的风险比（95%置信区间）分别为心力衰竭时收缩压和舒张压的时间趋势被进一步调整后，SD 参与者回归线的结果减弱。
收缩压变异性越大，心力衰竭保留射血分数的风险越高，与心力衰竭住院前的平均血压和冠状动脉事件无关。
