Lam Phillip H, Tsimploulis Apostolos, Patel Samir, Raman Venkatesh K, Arundel Cherinne, Faselis Charles, Deedwania Prakash, Sheikh Farooq H, Banerjee Sajal K, Allman Richard M, Fonarow Gregg C, Aronow Wilbert S, Ahmed Ali
Veterans Affairs Medical Center, Washington, DC, USA; Georgetown University, Washington, DC, USA; MedStar Washington Hospital Center, Washington, DC, USA.
Veterans Affairs Medical Center, Washington, DC, USA; George Washington University, Washington, DC, USA.
Prog Cardiovasc Dis. 2022 Jul-Aug;73:17-23. doi: 10.1016/j.pcad.2022.06.009. Epub 2022 Jun 28.
National heart failure (HF) guidelines recommend that in patients with HF with preserved ejection fraction (EF;HFpEF) and hypertension, systolic blood pressure (SBP) should be maintained below 130 mmHg. The objective of the study is to examine the association between initiation of anti-hypertensive drugs and outcomes in patients with HFpEF with persistent hypertension.
Of the 8873 hospitalized patients with HFpEF (EF ≥50%) with a history of hypertension without renal failure in Medicare-linked OPTIMIZE-HF, 3315 had a discharge SBP ≥130 mmHg, of whom 1971 were not receiving anti-hypertensive drugs, thiazides and calcium channel blockers, before hospitalization. Of these, 366 received discharge prescriptions for those drugs. We assembled a propensity score-matched cohort of 365 pairs of patients initiated and not initiated on anti-hypertensive drugs, balanced on 37 baseline characteristics. Hazard ratios (HR) and 95% confidence intervals (CI) for outcomes associated with anti-hypertensive drug initiation were estimated in the matched cohort.
Matched patients (n = 730) had a mean age of 78 years; 67% were women and 17% African Americans. During 6 (median 2.5) years of follow-up, 66% of the patients died and 45% had HF readmission. HRs (95% CIs) for all-cause mortality at 30 days, 12 months and 6 years associated with anti-hypertensive drug initiation were 0.64 (0.30-1.36), 0.70 (0.51-0.97), and 0.95 (0.79-1.13), respectively. Respective HRs (95% CIs) for HF readmission were 1.65 (0.97-2.80), 1.18 (0.90-1.56) and 1.09 (0.88-1.35).
Among hospitalized older patients with HFpEF with uncontrolled hypertension, the initiation of therapy with anti-hypertensive drugs was not associated with all-cause mortality or hospital readmission.
国家心力衰竭（HF）指南建议，对于射血分数保留的心力衰竭（EF；HFpEF）合并高血压患者，收缩压（SBP）应维持在130 mmHg以下。本研究的目的是探讨在持续性高血压的HFpEF患者中，启动抗高血压药物治疗与预后之间的关联。
在医疗保险关联的OPTIMIZE-HF研究中，8873例有高血压病史且无肾衰竭的住院HFpEF患者（EF≥50%）中，3315例出院时SBP≥130 mmHg，其中1971例在住院前未接受抗高血压药物、噻嗪类药物和钙通道阻滞剂治疗。其中，366例接受了这些药物的出院处方。我们根据37项基线特征，构建了一个倾向评分匹配队列，其中包括365对启动和未启动抗高血压药物治疗的患者。在匹配队列中估计与启动抗高血压药物治疗相关的预后的风险比（HR）和95%置信区间（CI）。
匹配患者（n = 730）的平均年龄为78岁；67%为女性，17%为非裔美国人。在6年（中位时间2.5年）的随访期间，66%的患者死亡，45%的患者因心力衰竭再次入院。启动抗高血压药物治疗后30天、12个月和6年的全因死亡率的HR（95%CI）分别为0.64（0.30-1.36）、0.70（0.51-0.97）和0.95（0.79-1.13）。因心力衰竭再次入院的相应HR（95%CI）分别为1.65（0.97-2.80）、1.18（0.90-1.56）和1.09（0.88-1.35）。
在住院的未控制高血压的老年HFpEF患者中，启动抗高血压药物治疗与全因死亡率或住院再入院无关。
