一线降压药物类别和强度对射血分数保留的心力衰竭患者NT-proBNP改善及心血管结局的影响：来自收缩压干预试验（SPRINT）的结果
Impact of first-line antihypertensive drug class and intensity on NT-proBNP improvement and cardiovascular outcomes among hypertensive patients with pre-heart failure: findings from SPRINT trial.
作者信息
Wang Lili, Yi Jiayi, Wang Wei, Zhou Zeming, Liu Jiamin, Zhang Haibo, Li Yan, Ren Xiangpeng, Lu Jiapeng, Zheng Xin
机构信息
National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, China.
Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
出版信息
Hypertens Res. 2024 Dec;47(12):3447-3457. doi: 10.1038/s41440-024-01873-7. Epub 2024 Oct 2.
Five first-line classes of antihypertensive drugs are recommended for hypertension treatment. However, it is unclear which class should be chosen for hypertensive patients with pre-heart failure (pre-HF). The study aimed to investigate the association between antihypertensive drug classes and intensity with probability of NT-proBNP (N-terminal pro-B-type natriuretic peptide) improvement and risk of cardiovascular events among pre-HF hypertensive patients. Utilizing the data from SPRINT, we included pre-HF hypertensive patients, identified by NT-proBNP ≥125 pg/mL at baseline. NT-proBNP improvement is defined as a reduction of ≥50% to a level below 125 pg/mL. A total of 3293 patients (mean age: 71.9 years; female: 43.8%) were included. NT-proBNP improvement was observed in 415 patients (12.6%) over 1-year follow up. Thiazide-type diuretics users were associated with a higher likelihood of NT-proBNP improvement (odds ratio [OR], 1.33; 95% confidence interval [CI], 1.05-1.70), a lower risk of HF (hazard ratio [HR], 0.54; 95% CI, 0.37-0.78) and primary composite outcome (HR, 0.72; 95% CI, 0.57-0.89). ACEI/ARB users were only associated with a lower risk of primary composite outcome (HR, 0.80; 95% CI, 0.63-0.99). In contrast, beta-blockers users were associated with a lower likelihood of NT-proBNP improvement (OR, 0.43; 95% CI, 0.34-0.55), while a higher risk of HF (HR, 1.79; 95% CI, 1.21-2.64) and primary composite outcome (HR, 1.48; 95% CI, 1.18-1.87). These associations varied across subgroups of different drug intensities. This post hoc analysis supports the use of thiazide-type diuretics and ACEI/ARB for prevention of cardiovascular events. The use of beta-blockers is associated with an increased risk of HF and primary outcomes, which requires further validation. Association between antihypertensive drug classes and intensity with NT-proBNP improvement and long-term clinical outcome.
高血压治疗推荐使用五类一线抗高血压药物。然而，对于伴有心力衰竭前期（pre-HF）的高血压患者应选择哪类药物尚不清楚。本研究旨在探讨抗高血压药物类别和用药强度与pre-HF高血压患者NT-proBNP（N末端B型利钠肽原）改善可能性及心血管事件风险之间的关联。利用收缩压干预试验（SPRINT）的数据，我们纳入了在基线时NT-proBNP≥125 pg/mL的pre-HF高血压患者。NT-proBNP改善定义为降低≥50%至低于125 pg/mL的水平。共纳入3293例患者（平均年龄：71.9岁；女性：43.8%）。在1年的随访中，415例患者（12.6%）出现NT-proBNP改善。使用噻嗪类利尿剂的患者NT-proBNP改善的可能性更高（优势比[OR]，1.33；95%置信区间[CI]，1.05 - 1.70），发生心力衰竭（HF）的风险更低（风险比[HR]，0.54；95% CI，0.37 - 0.78）以及发生主要复合结局的风险更低（HR，0.72；95% CI，0.57 - 0.89）。使用血管紧张素转换酶抑制剂（ACEI）/血管紧张素Ⅱ受体阻滞剂（ARB）的患者仅与主要复合结局风险较低相关（HR，0.80；95% CI，0.63 - 0.99）。相比之下，使用β受体阻滞剂的患者NT-proBNP改善的可能性较低（OR，0.43；95% CI，0.34 - 0.55），而发生HF的风险较高（HR，1.79；95% CI，1.21 - 2.64）以及发生主要复合结局的风险较高（HR，1.48；95% CI，1.18 - 1.87）。这些关联在不同药物强度的亚组中有所不同。这项事后分析支持使用噻嗪类利尿剂和ACEI/ARB预防心血管事件。使用β受体阻滞剂与HF风险及主要结局增加相关，这需要进一步验证。抗高血压药物类别和强度与NT-proBNP改善及长期临床结局之间的关联。
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