Diuretic use, progressive heart failure, and death in patients in the studies of left ventricular dysfunction (SOLVD)
Diuretic use, progressive heart failure, and death in patients in the studies of left ventricular dysfunction (SOLVD)
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DOI：
10.1016/s0735-1097(03)00765-4
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发表时间：
2003-08-20
影响因子：
24
通讯作者：
Peyster, E
中科院分区：
文献类型：
--
作者：
Domanski, M;Norman, J;Peyster, E
目的：我们试图确定在未使用保钾利尿剂（PSD）的情况下使用非保钾利尿剂是否会导致进行性心力衰竭（HF）。
背景：血管紧张素转换酶（ACE）抑制剂不能完全抑制心力衰竭患者的ACE活性。此外，非保钾利尿剂是醛固酮分泌的激活剂。我们推断在未使用保钾利尿剂的情况下，非保钾利尿剂可能导致进行性心力衰竭。
方法：在左心室功能障碍研究（SOLVD）的6797名患者中，我们对使用保钾利尿剂和未使用保钾利尿剂的患者进行了比较，分析因心力衰竭住院或死亡的风险，并对已知的协变量进行了调整。
结果：与仅使用非保钾利尿剂的患者相比，使用保钾利尿剂的患者因心力衰竭恶化住院的风险为0.74（95%置信区间[CI]为0.55 - 0.99；p = 0.047）。心血管死亡的相对风险为0.74（95%CI为0.59 - 0.93；p = 0.011），全因死亡的相对风险为0.73（95%CI为0.59 - 0.90；p = 0.004），因心力衰竭住院或死亡的相对风险为0.75（95%CI为0.58 - 0.97；p = 0.030）。与未使用任何利尿剂的患者相比，仅使用非保钾利尿剂的患者因心力衰竭恶化住院或死亡的风险显著增加（风险比[RR] = 1.31，95%CI为1.09 - 1.57；p = 0.0004）；在使用保钾利尿剂（无论是否同时使用非保钾利尿剂）的患者中未观察到这种情况（RR = 0.99，95%CI为0.76 - 1.30；p = 0.95）。
结论：与仅使用非保钾利尿剂的患者相比，心力衰竭患者使用保钾利尿剂与进行性心力衰竭、全因死亡或心血管死亡的住院或死亡风险降低相关。（C）2003年美国心脏病学会基金会
OBJECTIVES We sought to determine whether non-potassium-sparing diuretics (PSDs) in the absence of a PSD may result in progressive heart failure (HF).BACKGROUND Angiotensin-converting enzyme (ACE) inhibitors incompletely suppress ACE activity in HF patients. Furthermore, non-PSDs are activators of aldosterone secretion. We reasoned that non-PSDs, in the absence of a PSD, might result in progressive HF.METHODS In the 6,797 patients in the Studies Of Left Ventricular Dysfunction (SOLVD), we compared the risk of hospitalization for, or death from, HF between those taking a PSD and those who were not, adjusting for known covariates.RESULTS The risk of hospitalization from worsening HF in those taking a PSD relative to those taking only a non-PSD was 0.74 (95% confidence interval [CI] 0.55 to 0.99; p = 0.047). The relative risk for cardiovascular death was 0.74 (95% CI 0.59 to 0.93; p = 0.011), for death from all causes 0.73 (95% CI 0.59 to 0.90; p = 0.004), and for hospitalization for, or death from, HF 0.75 (95% CI 0.58 to 0.97; p = 0.030). Compared with patients not taking any diuretic, the risk of hospitalization or death due to worsening HF in patients taking non-PSDs alone was significantly increased (risk ratio [RR] = 1.31, 95% CI 1.09 to 1.57; p = 0.0004); this was not observed in patients taking PSDs with or without a non-PSD (RR = 0.99, 95% CI 0.76 to 1.30; p = 0.95).CONCLUSIONS The use of PSDs in HF patients is associated with a reduced risk of death from, or hospitalization for, progressive HF or all-cause or cardiovascular death, compared with patients taking only a non-PSD. (C) 2003 by the American College of Cardiology Foundation.