Fang Yipeng, Huang Xianxi, Shi Junyu, Ren Chunhong, Zhang Xin
Laboratory of Molecular Cardiology, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong Province, China.
Laboratory of Medical Molecular Imaging, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong Province, China.
Front Pharmacol. 2024 Aug 28;15:1385397. doi: 10.3389/fphar.2024.1385397. eCollection 2024.
To investigate the effect of different single and combined pre-admission antihypertensive drug regimens on the prognosis of critically ill patients.
We performed a retrospective cohort study using data from the Medical Information Mart for Intensive Care-IV (MIMIC-IV) database. All initial ICU admission records of patients with hypertension and previous antihypertensive exposure before ICU admission were included. Our primary outcome was 90-day mortality. Propensity score matching (PSM) and inverse probability of treatment weighting (IPTW) were used to balance the distribution of baseline characteristics. Logistic regression analysis and subgroup analysis were performed to determine the independent effect of different single and combined antihypertensive drug regimens on 90-day mortality.
A total of 13,142 patients were included in the final analysis. The 90-day mortality rate in the combined groups is lower than that in the single therapy group (10.94% vs 11.12%), but no statistical significance was found in the original cohort ( = 0.742). After adjustment for potential confounders, the significantly decreased 90-day mortality rate was found in the combined groups (10.78% vs 12.65%, = 0.004 in PSM; 10.34% vs 11.90%, = 0.007). Patients who were exposed to either ACEIs or ARBs had a better prognosis than those not exposed (7.19% vs 17.08%, < 0.001 in single antihypertensive groups; 8.14% vs18.91%, < 0.001 in combined antihypertensive groups). The results keep robustness in the PSM and IPTW cohorts. In the logistic regression model analysis, combined therapy was associated with a 12%-20% reduced risk of 90-day death after adjusting potential confounders (OR 0.80-0.88, all < 0.05), while exposure to ACEIs or ARBs was associated with the decreased risk of 90-day death by 52%-62% (OR 0.38-0.48, all < 0.001) and 40%-62% (OR 0.38-0.60, all < 0.001) in the single and combined therapy groups, respectively. The results were still robust to subgroup analysis.
Pre-admission combined antihypertensive therapy is associated with a significantly lower risk of death than exposure to single antihypertensives in critically ill patients. Meanwhile, either ACEIs or ARBs seem to be the optimal candidates for both single and combined therapy. Further high-quality trials are needed to confirm our findings.
探讨不同的单一及联合入院前降压药物治疗方案对危重症患者预后的影响。
我们利用重症监护医学信息集市-IV（MIMIC-IV）数据库的数据进行了一项回顾性队列研究。纳入所有高血压且在重症监护病房（ICU）入院前曾接受过降压治疗的患者的首次ICU入院记录。我们的主要结局是90天死亡率。采用倾向评分匹配（PSM）和逆概率加权法（IPTW）来平衡基线特征的分布。进行逻辑回归分析和亚组分析，以确定不同单一及联合降压药物治疗方案对90天死亡率的独立影响。
最终分析共纳入13142例患者。联合治疗组的90天死亡率低于单一治疗组（10.94%对11.12%），但在原队列中未发现统计学意义（P = 0.742）。在调整潜在混杂因素后，联合治疗组的90天死亡率显著降低（PSM中为10.78%对12.65%，P = 0.004；IPTW中为10.34%对11.90%，P = 0.007）。接受血管紧张素转换酶抑制剂（ACEIs）或血管紧张素Ⅱ受体阻滞剂（ARBs）治疗的患者比未接受治疗的患者预后更好（单一降压治疗组中为7.19%对17.08%，P < 0.001；联合降压治疗组中为8.14%对18.91%，P < 0.001）。这些结果在PSM和IPTW队列中保持稳健性。在逻辑回归模型分析中，调整潜在混杂因素后，联合治疗与90天死亡风险降低12%-20%相关（比值比[OR]为0.80-0.88，均P < 0.05），而在单一和联合治疗组中，接受ACEIs或ARBs治疗分别与降低90天死亡风险52%-62%（OR为0.38-0.48，均P < 0.001）和40%-62%（OR为0.38-0.60，均P < 0.001）相关。亚组分析结果仍然稳健。
与单一降压治疗相比，入院前联合降压治疗与危重症患者的死亡风险显著降低相关。同时，ACEIs或ARBs似乎是单一治疗和联合治疗的最佳选择。需要进一步的高质量试验来证实我们的发现。
