Uncontrolled hypertension and increased risk for incident heart failure in older adults with hypertension: findings from a propensity-matched prospective population study.
Uncontrolled hypertension and increased risk for incident heart failure in older adults with hypertension: findings from a propensity-matched prospective population study.
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DOI：
10.1016/j.jash.2010.02.002
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发表时间：
2010-01
期刊：
影响因子：
--
通讯作者：
Ahmed A
中科院分区：
文献类型：
--
作者：
Iyer AS;Ahmed MI;Filippatos GS;Ekundayo OJ;Aban IB;Love TE;Nanda NC;Bakris GL;Fonarow GC;Aronow WS;Ahmed A
高血压是发生心力衰竭（HF）的危险因素。然而，未控制的血压（BP）对老年高血压患者发生HF的影响尚未在倾向匹配研究中进行前瞻性研究。在5795例≥65岁的心血管健康研究参与者中，2562例自我报告的医生诊断的高血压患者基线时无HF。其中，1391例患有不受控制的高血压，定义为收缩压（SBP）≥140（n=1373）或舒张压≥90 mm Hg（n=18）。计算每个参与者的未控制高血压倾向评分，用于收集1021对在31个基线特征上平衡的控制和未控制高血压参与者的队列。在13年的随访期间，中心裁定的HF事件分别发生在23%和26%的高血压控制和不控制的参与者中（当不控制的高血压与不控制的高血压相比时，匹配的风险比{HR}为1.39; 95%置信区间{CI}为1.12-1.73; P=0.003）。慢性肾脏疾病（CKD）患者（n=503）和非CKD患者（n=1539）发生HF的HR（95% CI）分别为1.73（95% CI，1.26-2.38; P=0.001）和1.08（95% CI，0.87-1.34; P=0.486）（相互作用P，0.012）。与高血压得到控制的受试者相比，SBP 140-159和≥160 mm Hg的HF事件的HR分别为1.06（95% CI，0.86-1.31; P=0.572）和1.58（95% CI，1.27-1.96; P<0.0001）。在社区居住的老年高血压患者中，血压不受控制（与控制相比）的患者新发HF的风险增加，这在SBP≥160 mm Hg和CKD患者中更为明显。
Hypertension is a risk factor for incident heart failure (HF). However, the effect of uncontrolled blood pressure (BP) on incident HF in older adults with hypertension has not been prospectively examined in propensity-matched studies. Of the 5795 Cardiovascular Health Study participants, ≥65 years, 2562 with self-reported physician-diagnosed hypertension had no baseline HF. Of these, 1391 had uncontrolled hypertension, defined as systolic BP (SBP) ≥140 (n=1373) or diastolic BP ≥90 mm Hg (n=18). Propensity scores for uncontrolled hypertension, calculated for each participant, were used to assemble a cohort of 1021 pairs of participants with controlled and uncontrolled hypertension who were balanced on 31 baseline characteristics. Centrally adjudicated incident HF developed in 23% and 26% of participants with controlled and uncontrolled hypertension respectively during 13 years of follow-up (matched hazard ratio {HR} when uncontrolled hypertension was compared with uncontrolled hypertension, 1.39; 95% confidence interval {CI}, 1.12–1.73; P=0.003). HR’s (95% CI’s) for incident HF for those with (n=503) and without (n=1539) chronic kidney disease (CKD) were 1.73 (95% CI, 1.26–2.38; P=0.001) and 1.08 (95% CI, 0.87–1.34; P=0.486) respectively (P for interaction, 0.012). Compared with participants with controlled hypertension, HR’s for incident HF associated with SBP 140–159 and ≥160 mm Hg were 1.06 (95% CI, 0.86–1.31; P=0.572) and 1.58 (95% CI, 1.27–1.96; P<0.0001) respectively. In community-dwelling older adults with hypertension, those with uncontrolled (versus controlled) BP has increased risk of new-onset HF, which is more pronounced in those with SBP≥160 mm Hg and with CKD.
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