Diastolic Blood Pressure and Adverse Outcomes in the TOPCAT (Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist) Trial.
Diastolic Blood Pressure and Adverse Outcomes in the TOPCAT (Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist) Trial.
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DOI：
10.1161/jaha.117.007475
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发表时间：
2018-02-23
影响因子：
5.4
通讯作者：
Sperling LS
中科院分区：
文献类型：
--
作者：
Sandesara PB;O'Neal WT;Kelli HM;Topel M;Samman-Tahhan A;Sperling LS
尽管舒张压（DBP）在一般人群中与心血管不良结局的风险增加独立相关，但在保留射血分数的心力衰竭患者中是否存在类似的关系尚不清楚。该分析纳入了1703例（平均年龄72±10岁；50%男性；78%白人）参加TOPCAT（使用醛固酮拮抗剂治疗保留心功能心力衰竭）试验的美洲高血压患者，这些患者有保留射血分数。多变量Cox回归用于检查与舒张压相关的心力衰竭、死亡和心血管死亡的住院风险。心衰住院与舒张压之间呈线性关系，舒张压值越低，心衰风险越高（≥90 mm Hg：参考值；80-89 mm Hg：危险比[HR] 1.44； 95%可信区间[CI] 0.85-2.44； 70-79 mm Hg：危险比[HR] 1.18; 95% CI 0.69-2.01； 60 - 69 mm Hg：危险比[HR] 1.54; 95% CI 0.90-2.63; <60 mm Hg：危险比，2.12;95% CI 1.20-3.74；趋势P=0.0055）。DBP与死亡（≥90 mm Hg: HR, 1.86; 95% CI, 1.12-3.06; 80-89 mm Hg: HR, 1.23; 95% CI, 0.89-1.70； 70-79 mm Hg：参考；60 - 69 mm Hg: HR, 1.20; 95% CI, 0.90-1.59; <60 mm Hg: HR, 1.68; 95% CI, 1.21-2.33）和心血管死亡(≥90 mm Hg: HR, 2.02; 95% CI, 1.10-3.71; 80-89 mm Hg: HR, 1.17; 95% CI, 0.77-1.79； 70-79 mm Hg：参考；60 - 69 mm Hg: HR, 1.16; 95% CI, 0.80-1.70; <60 mm Hg: HR, 1.85；95% CI, 1.21-2.82)是非线性的，当DBP值≥90和<60 mm Hg时，观察到的每种结果的风险都更大。DBP值≥90和<60 mm Hg与接受高血压治疗的保留射血分数的心力衰竭患者不良结局的显著风险相关。需要进一步的研究来确定最佳舒张压目标，以降低保留射血分数的心力衰竭患者不良事件的风险。
Although diastolic blood pressure (DBP) is independently associated with an increased risk of adverse cardiovascular outcomes in the general population, it is unclear if a similar relationship exists in patients with heart failure with preserved ejection fraction. This analysis included 1703 (mean age, 72±10 years; 50% men; 78% white) patients with heart failure with preserved ejection fraction enrolled in the TOPCAT (Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist) Trial from the Americas who were treated for hypertension. Multivariable Cox regression was used to examine the risk of hospitalization for heart failure, death, and cardiovascular death associated with DBP. The relationship between hospitalization for heart failure and DBP was linear, with an increased risk observed with decreasing DBP values (≥90 mm Hg: referent; 80–89 mm Hg: hazard ratio [HR], 1.44; 95% confidence interval [CI], 0.85–2.44; 70–79 mm Hg: HR, 1.18; 95% CI, 0.69–2.01; 60–69 mm Hg: HR, 1.54; 95% CI, 0.90–2.63; <60 mm Hg: HR, 2.12; 95% CI, 1.20–3.74; P=0.0055 for trend). The associations of DBP with death (≥90 mm Hg: HR, 1.86; 95% CI, 1.12–3.06; 80–89 mm Hg: HR, 1.23; 95% CI, 0.89–1.70; 70–79 mm Hg: referent; 60–69 mm Hg: HR, 1.20; 95% CI, 0.90–1.59; <60 mm Hg: HR, 1.68; 95% CI, 1.21–2.33) and cardiovascular death (≥90 mm Hg: HR, 2.02; 95% CI, 1.10–3.71; 80–89 mm Hg: HR, 1.17; 95% CI, 0.77–1.79; 70–79 mm Hg: referent; 60–69 mm Hg: HR, 1.16; 95% CI, 0.80–1.70; <60 mm Hg: HR, 1.85; 95% CI, 1.21–2.82) were nonlinear, with a greater risk of each outcome observed with DBP values ≥90 and <60 mm Hg. DBP values ≥90 and <60 mm Hg are associated with a significant risk of adverse outcomes in patients with heart failure with preserved ejection fraction who are treated for hypertension. Further research is needed to determine optimal DBP targets to reduce the risk of adverse events in patients with heart failure with preserved ejection fraction.