因心力衰竭住院患者的收缩压与1年临床结局
Systolic Blood Pressure and 1-Year Clinical Outcomes in Patients Hospitalized for Heart Failure.
作者信息
Huang Xinghe, Liu Jiamin, Zhang Lihua, Wang Bin, Bai Xueke, Hu Shuang, Miao Fengyu, Tian Aoxi, Yang Tingxuan, Li Yan, Li Jing
机构信息
Fuwai Hospital, Chinese Academy of Medical Sciences, Shenzhen, China.
National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, China.
出版信息
Front Cardiovasc Med. 2022 Apr 25;9:877293. doi: 10.3389/fcvm.2022.877293. eCollection 2022.
BACKGROUND
High systolic blood pressure (SBP) is an important risk factor for the progression of heart failure (HF); however, the association between SBP and prognosis among patients with established HF was uncertain. This study aimed to investigate the association between SBP and long-term clinical outcomes in patients hospitalized for HF.
METHODS
This study prospectively enrolled adult patients hospitalized for HF in 52 hospitals from 20 provinces in China. SBPs were measured in a stable condition judged by clinicians during hospitalization before discharge according to the standard research protocol. The primary outcomes included 1-year all-cause death and HF readmission. The multivariable Cox proportional hazards regression models were fitted to examine the association between SBP and clinical outcomes. Restricted cubic splines were used to examine the non-linear associations.
RESULTS
The 4,564 patients had a mean age of 65.3 ± 13.5 years and 37.9% were female. The average SBP was 123.2 ± 19.0 mmHg. One-year all-cause death and HF readmission were 16.9 and 32.7%, respectively. After adjustment, patients with SBP < 110 mmHg had a higher risk of all-cause death compared with those with SBP of 130-139 mmHg (HR 1.71; 95% CI: 1.32-2.20). Patients with SBP < 110 mmHg (HR 1.36; 95% CI: 1.14-1.64) and SBP ≥ 150 mmHg (HR 1.26; 95% CI: 1.01-1.58) had a higher risk of HF readmission, and the association between SBP and HF readmission followed a J-curve relationship with the nadir SBP around 130 mmHg. These associations were consistent regardless of age, sex, left ventricular ejection fraction, hypertension, coronary heart disease, and medications for HF.
CONCLUSION
In patients hospitalized for HF, lower SBP in a stable phase during hospitalization portends an increased risk of 1-year death, and a J-curve association has been observed between SBP and 1-year HF readmission. These associations were consistent among clinically important subgroups.
背景
收缩压升高是心力衰竭（HF）进展的重要危险因素；然而，已确诊HF患者的收缩压与预后之间的关联尚不确定。本研究旨在调查因HF住院患者的收缩压与长期临床结局之间的关联。
方法
本研究前瞻性纳入了来自中国20个省份52家医院因HF住院的成年患者。根据标准研究方案，在出院前住院期间由临床医生判断为稳定状态时测量收缩压。主要结局包括1年全因死亡和HF再入院。采用多变量Cox比例风险回归模型来检验收缩压与临床结局之间的关联。使用受限立方样条来检验非线性关联。
结果
4564例患者的平均年龄为65.3±13.5岁，女性占37.9%。平均收缩压为123.2±19.0 mmHg。1年全因死亡和HF再入院率分别为16.9%和32.7%。调整后，收缩压<110 mmHg的患者与收缩压为130 - 139 mmHg的患者相比，全因死亡风险更高（风险比1.71；95%置信区间：1.32 - 2.20）。收缩压<110 mmHg（风险比1.36；95%置信区间：1.14 - 1.64）和收缩压≥150 mmHg（风险比1.26；95%置信区间：1.01 - 1.58）的患者HF再入院风险更高，收缩压与HF再入院之间的关联呈J曲线关系，最低点收缩压约为130 mmHg。无论年龄、性别、左心室射血分数、高血压、冠心病以及HF用药情况如何，这些关联均一致。
结论
在因HF住院的患者中，住院期间稳定期较低的收缩压预示着1年死亡风险增加，并且在收缩压与1年HF再入院之间观察到J曲线关联。这些关联在临床上重要的亚组中是一致的。
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