Rocha Helena, Gouveia Rita, Elias Catarina, Reis Catarina, Fonseca Ana Margarida, Costa Adriana, Guimarães Carolina, Ribeiro Rui, Toste Ana, Grijó Carlos, Reis Helena, Neves Ana, Almeida Jorge, Lourenço Patrícia
Internal Medicine Department, Centro Hospitalar de São João, Porto, Portugal.
Department of Medicine, Faculty of Medicine, Porto University, Porto, Portugal.
Porto Biomed J. 2025 Mar 18;10(2):e284. doi: 10.1097/j.pbj.0000000000000284. eCollection 2025 Mar-Apr.
The impact of systolic blood pressure (SBP) variation on chronic heart failure (HF) is largely unknown. We assessed the impact of SBP variation in patients with chronic HF.
This is a retrospective analysis of adult ambulatory patients with HF with left ventricular systolic dysfunction (LVSD). SBP variation = SBP at the index visit - SBP at the 1-year visit. Patients dying in the first year or with missing data concerning SBP were excluded. Patients with SBP increase ≥10 mmHg during the first year were compared with the remaining. Determinants of SBP increase were assessed by binary logistic regression analysis. The patients were followed up from the 1-year visit up to 5 years. The primary end point was all-cause mortality. A Cox regression analysis was used to determine the association of SBP variation with mortality.
We studied 787 patients (68% male), with a mean age of 70 years. SBP increased by ≥10 mmHg in 277 patients (35.2%) and remained stable or decreased in 510. Patients in whom SBP increased more often presented severe LVSD and nonischemic HF; they had lower baseline SBP and were more medicated with loop diuretics. Independent predictors of SBP increase were lower basal SBP and loop diuretic use. Patients with a SBP increase ≥10 mmHg had a crude hazard ratio (HR) of all-cause mortality of 0.74 (0.59-0.94), and the multivariate-adjusted HR was 0.61 (0.46-0.79).
Patients with chronic HF with SBP increase ≥10 mmHg over the first year have a 39% reduction in the all-cause mortality risk irrespective of basal SBP, severity of ventricular dysfunction, and evidence-based drug use. Patients with SBP stability or decrease have a similarly poor prognosis.
收缩压（SBP）变化对慢性心力衰竭（HF）的影响很大程度上尚不清楚。我们评估了慢性HF患者中SBP变化的影响。
这是一项对成年门诊左心室收缩功能障碍（LVSD）的HF患者的回顾性分析。SBP变化=首次就诊时的SBP - 1年随访时的SBP。排除在第一年死亡或有SBP缺失数据的患者。将第一年SBP升高≥10 mmHg的患者与其余患者进行比较。通过二元逻辑回归分析评估SBP升高的决定因素。患者从1年随访起随访至5年。主要终点是全因死亡率。采用Cox回归分析确定SBP变化与死亡率的关联。
我们研究了787例患者（68%为男性），平均年龄70岁。277例患者（35.2%）的SBP升高≥10 mmHg，510例患者的SBP保持稳定或下降。SBP升高的患者更常表现为严重LVSD和非缺血性HF；他们的基线SBP较低，使用袢利尿剂的比例更高。SBP升高的独立预测因素是较低的基础SBP和使用袢利尿剂。SBP升高≥10 mmHg的患者全因死亡率的粗风险比（HR）为0.74（0.59 - 0.94），多变量调整后的HR为0.61（0.46 - 0.79）。
在第一年SBP升高≥10 mmHg的慢性HF患者，无论基础SBP、心室功能障碍的严重程度和循证药物使用情况如何，全因死亡风险降低39%。SBP稳定或下降的患者预后同样较差。
