Division of Cardiology, Department of Internal Medicine, Hanyang University College of Medicine, Hanyang University Guri Hospital, Guri, Korea.
Cardiovascular Center, Hallym University Sacred Heart Hospital, Anyang-si, Korea.
Sci Rep. 2024 Jul 6;14(1):15605. doi: 10.1038/s41598-024-66219-2.
Low blood pressure (BP) is associated with poor outcomes in patients with heart failure (HF). We investigated the influence of initial BP on the prognosis of HF patients at admission, and prescribing patterns of HF medications, such as angiotensin-converting enzyme inhibitors (ACEi), angiotensin receptor blockers (ARB), and beta-blockers (BB). Data were sourced from a multicentre cohort of patients admitted for acute HF. Patients were grouped into heart failure reduced ejection fraction (HFrEF) and HF mildly reduced/preserved ejection fraction (HFmrEF/HFpEF) groups. Initial systolic and diastolic BPs were categorized into specific ranges. Among 2778 patients, those with HFrEF were prescribed ACEi, ARB, or BB at discharge, regardless of their initial BP. However, medication use in HFmrEF/HFpEF patients tended to decrease as BP decreased. Lower initial BP in HFrEF patients correlated with an increased incidence of all-cause death and composite clinical events, including HF readmission or all-cause death. However, no significant differences in clinical outcomes were observed in HFmrEF/HFpEF patients according to BP. Initial systolic (< 120 mmHg) and diastolic (< 80 mmHg) BPs were independently associated with a 1.81-fold (odds ratio [OR] 1.81, 95% confidence interval [CI] 1.349-2.417, p < 0.001) and 2.24-fold (OR 2.24, 95% CI 1.645-3.053, p < 0.001) increased risk of long-term mortality in HFrEF patients, respectively. In conclusion, low initial BP in HFrEF patients correlated with adverse clinical outcomes, and BP < 120/80 mmHg independently increased mortality. However, this relationship was not observed in HFmrEF/HFpEF patients.
低血压（BP）与心力衰竭（HF）患者的不良预后相关。我们研究了入院时初始 BP 对 HF 患者预后的影响，以及 HF 药物（如血管紧张素转换酶抑制剂[ACEi]、血管紧张素受体阻滞剂[ARB]和β受体阻滞剂[BB]）的处方模式。数据来自急性 HF 多中心队列患者。患者分为射血分数降低性心力衰竭（HFrEF）和射血分数轻度降低/保留性心力衰竭（HFmrEF/HFpEF）组。将初始收缩压和舒张压分为特定范围。在 2778 例患者中，无论初始 BP 如何，HFrEF 患者在出院时均开具 ACEi、ARB 或 BB。然而，HFmrEF/HFpEF 患者的药物使用率随 BP 降低而降低。HFrEF 患者的初始 BP 较低与全因死亡和复合临床事件（包括 HF 再入院或全因死亡）发生率增加相关。然而，根据 BP，HFmrEF/HFpEF 患者的临床结局无显著差异。初始收缩压（<120mmHg）和舒张压（<80mmHg）与 HFrEF 患者的 1.81 倍（比值比[OR]1.81，95%置信区间[CI]1.349-2.417，p<0.001）和 2.24 倍（OR 2.24，95% CI 1.645-3.053，p<0.001）的长期死亡率风险增加相关。总之，HFrEF 患者的初始 BP 较低与不良临床结局相关，BP<120/80mmHg 可独立增加死亡率。然而，在 HFmrEF/HFpEF 患者中未观察到这种关系。
