基于随访间脉压变异性评估对高血压患者心力衰竭事件的影响：SPRINT 试验的见解。
Impact of pulse pressure variability evaluated by visit-to-visit on heart failure events in patients with hypertension: insights from the SPRINT trial.
机构信息
School of Public Health, Zhejiang Chinese Medical University, Hangzhou, China.
School of Human Sciences, Waseda University, Shinjuku, Japan.
出版信息
Eur J Med Res. 2024 Nov 24;29(1):559. doi: 10.1186/s40001-024-02164-0.
OBJECTIVES
In adult hypertensive patients, blood pressure variability is considered a risk factor for heart failure. The relationship between pulse pressure variability and the risk of heart failure remains unclear. This study aims to explore the impact of pulse pressure variability (PPV) on heart failure through a secondary analysis of the SPRINT randomized controlled trial.
METHODS
The data were derived from the SPRINT (Systolic Blood Pressure Intervention Trial) study. The trial recruited participants 50 years or older, with SBP ≥ 130 mm Hg and at least one additional CVD risk factor. We calculated pulse pressure based on the systolic and diastolic blood pressure obtained during follow-up, and used the coefficient of variation to represent pulse pressure variability (PPV) for statistical analysis. We considered the incidence of acute decompensated heart failure as the outcome measure. We employed multivariable Cox regression analysis to examine the relationship between PPV and the risk of heart failure occurrence. Additionally, we used a restricted cubic spline model to analyze the dose-response relationship between PPV and the risk of heart failure occurrence.
RESULTS
In this study, a total of 9429 participants were included. During a median follow-up time of 3.87 years, 188 new cases of heart failure were observed. The mean age of the study population was 67.9 ± 9.4 years and 3382 participants (35.5%) were females. The average PPCV was 13.85 ± 5.37%. The results from the multivariable Cox regression analysis indicated that the risk of heart failure increased by 3% for every 1% increase in PPCV (HR = 1.030 [95% CI 1.016-1.044]; P < 0.001).
CONCLUSIONS
The study found that PPV is an independent risk factor for the occurrence of heart failure. This underscores the importance of maintaining long-term stability in pulse pressure, in preventing the development of heart failure.
目的
在成年高血压患者中，血压变异性被认为是心力衰竭的一个危险因素。脉压变异性与心力衰竭风险之间的关系尚不清楚。本研究旨在通过 SPRINT 随机对照试验的二次分析探讨脉压变异性（PPV）对心力衰竭的影响。
方法
数据来自 SPRINT（收缩压干预试验）研究。该试验招募了年龄在 50 岁及以上、收缩压≥130mmHg 且至少有一个其他心血管疾病危险因素的参与者。我们根据随访期间获得的收缩压和舒张压计算脉压，并使用变异系数表示脉压变异性（PPV）进行统计分析。我们将急性失代偿性心力衰竭的发生率作为结局指标。我们采用多变量 Cox 回归分析来研究 PPV 与心力衰竭发生风险之间的关系。此外，我们还使用受限立方样条模型来分析 PPV 与心力衰竭发生风险之间的剂量-反应关系。
结果
本研究共纳入 9429 名参与者。在中位数为 3.87 年的随访期间，观察到 188 例新发心力衰竭。研究人群的平均年龄为 67.9±9.4 岁，3382 名参与者（35.5%）为女性。平均 PPCV 为 13.85±5.37%。多变量 Cox 回归分析结果表明，PPV 每增加 1%，心力衰竭风险增加 3%（HR=1.030[95%CI 1.016-1.044]；P<0.001）。
结论
本研究发现 PPV 是心力衰竭发生的独立危险因素。这强调了长期维持脉压稳定对预防心力衰竭发展的重要性。
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