Emergency Center, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease of China, National Center for Cardiovascular Diseases, National Clinical Research Center of Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China.
Hypertension Center, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease of China, National Center for Cardiovascular Diseases of China, National Clinical Research Center of Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China.
Chin Med J (Engl). 2023 Mar 20;136(6):683-689. doi: 10.1097/CM9.0000000000002627.
The ideal blood pressure (BP) target for patients with atrial fibrillation (AF) is still unclear. The present study aimed to assess the effect of the baseline BP on all-cause mortality in patients with AF.
This registry study included 20 emergency centers across China and consecutively enrolled patients with AF from 2008 to 2011. All participants were followed for 1 year ± 1 month. The primary endpoint was all-cause mortality.
During the follow-up, 276 (13.9%) all-cause deaths occurred. Kaplan-Meier curves showed that a systolic blood pressure (SBP) ≤110 mmHg or >160 mmHg was associated with a higher risk of all-cause mortality (log-rank test, P = 0.014), and a diastolic blood pressure (DBP) <70 mmHg was associated with the highest risk of all-cause mortality (log-rank test, P = 0.002). After adjusting for confounders, the multivariable Cox regression model suggested that the risk of all-cause mortality was increased in the group with SBP ≤110 mmHg (hazard ratio [HR], 1.963; 95% confidence interval [CI], 1.306-2.951), and DBP <70 mmHg (HR, 1.628; 95% CI, 1.163-2.281). In the restricted cubic splines, relations between baseline SBP or DBP and all-cause mortality showed J-shaped associations (non-linear P <0.001 and P = 0.010, respectively). The risk of all-cause mortality notably increased at a lower baseline SBP and DBP.
Having a baseline SBP ≤110 mmHg or DBP <70 mmHg was associated with a significantly higher risk of all-cause mortality in patients with AF. An excessively low BP may not be an optimal target for patients with AF.
目前对于房颤患者的理想血压（BP）目标仍不明确。本研究旨在评估基线 BP 对房颤患者全因死亡率的影响。
本注册研究纳入了中国 20 家急救中心，连续纳入 2008 年至 2011 年的房颤患者。所有患者随访 1 年±1 个月。主要终点为全因死亡率。
随访期间，276 例（13.9%）发生全因死亡。Kaplan-Meier 曲线显示，收缩压（SBP）≤110mmHg 或＞160mmHg 与全因死亡率升高相关（log-rank 检验，P=0.014），舒张压（DBP）＜70mmHg 与全因死亡率升高相关（log-rank 检验，P=0.002）。调整混杂因素后，多变量 Cox 回归模型表明，SBP≤110mmHg 组（危险比[HR]，1.963；95%置信区间[CI]，1.306-2.951）和 DBP＜70mmHg 组（HR，1.628；95%CI，1.163-2.281）的全因死亡率风险增加。在限制三次样条中，基线 SBP 或 DBP 与全因死亡率之间的关系呈 J 形关联（非线性 P＜0.001 和 P=0.010）。较低的基线 SBP 和 DBP 与全因死亡率显著增加的风险相关。
基线 SBP≤110mmHg 或 DBP＜70mmHg 与房颤患者的全因死亡率显著升高相关。过低的血压可能不是房颤患者的最佳目标。
