Guo Siyu, Liu Xiao, Gu Zhenbang, Sun Junyi, Cao Yalin, Zhu Wengen
Department of Cardiology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510080, PR China.
Department of Cardiology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, 510030, PR China.
Heliyon. 2024 Mar 7;10(6):e27551. doi: 10.1016/j.heliyon.2024.e27551. eCollection 2024 Mar 30.
Whether the hypertension burden is associated with stroke incidence is inconclusive. In this study, we aimed to investigate the relationship between hypertension burden and stroke risk in patients with heart failure with preserved ejection fraction (HFpEF).
HFpEF patients from the Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist (TOPCAT) trial were divided into three groups (low, medium, and high risk) according to their hypertension burden values. Higher hypertension burden risk represented the longer duration of hypertension. We evaluated the association of hypertension burden with stroke risk using Fine and Gray's competing risk models.
A total of 3431 HFpEF patients (mean age: 68.5 ± 9.58 years, 51.6% females) were enrolled. During a median follow-up of 3.3 years, per 10-point increase in hypertension burden was associated with any stroke (hazard ratio [HR] 1.15, 95% confidence interval [CI] 1.08-1.21), new-onset stroke (HR 1.14, 95% CI 1.07-1.21), and ischemic stroke (HR 1.10, 95% CI 1.02-1.17). When hypertension burden was analyzed as a categorical variable, any stroke risk was increased in the medium- (HR 1.59, 95% CI 1.01-2.40) and high-risk (HR 3.19, 95% CI 2.05-4.97) groups when compared with the low-risk group. For the outcomes of new-onset (HR 2.92, 95% CI 1.80-4.74) and ischemic stroke (HR 2.46, 95% CI 1.41-4.29), similar results were observed in patients with high-versus low-risk hypertension burden.
Increasing hypertension burden was associated with an increased risk of stroke, suggesting that shortening hypertension duration might appropriately minimize the stroke incidence in HFpEF patients.
高血压负担是否与中风发病率相关尚无定论。在本研究中，我们旨在探讨射血分数保留的心力衰竭（HFpEF）患者的高血压负担与中风风险之间的关系。
来自醛固酮拮抗剂治疗保留心功能心力衰竭（TOPCAT）试验的HFpEF患者根据其高血压负担值分为三组（低、中、高风险）。较高的高血压负担风险代表高血压持续时间较长。我们使用Fine和Gray的竞争风险模型评估高血压负担与中风风险的关联。
共纳入3431例HFpEF患者（平均年龄：68.5±9.58岁，51.6%为女性）。在中位随访3.3年期间，高血压负担每增加10分与任何中风（风险比[HR]1.15，95%置信区间[CI]1.08 - 1.21）、新发中风（HR 1.14，95%CI 1.07 - 1.21）和缺血性中风（HR 1.10，95%CI 1.02 - 1.17）相关。当将高血压负担作为分类变量进行分析时，与低风险组相比，中风险组（HR 1.59，95%CI 1.01 - 2.40）和高风险组（HR 3.19，95%CI 2.05 - 4.97）的任何中风风险均增加。对于新发中风（HR 2.92，95%CI 1.80 - 4.74）和缺血性中风（HR 2.46，95%CI 1.41 - 4.29）的结果，在高风险与低风险高血压负担的患者中观察到类似结果。
高血压负担增加与中风风险增加相关，这表明缩短高血压持续时间可能适当地降低HFpEF患者的中风发病率。
