Influence of Titration of Neurohormonal Antagonists and Blood Pressure Reduction on Renal Function and Decongestion in Decompensated Heart Failure
Influence of Titration of Neurohormonal Antagonists and Blood Pressure Reduction on Renal Function and Decongestion in Decompensated Heart Failure
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DOI：
10.1161/circheartfailure.115.002333
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发表时间：
2016-01-01
影响因子：
9.7
通讯作者：
Testani, Jeffrey M.
中科院分区：
文献类型：
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作者：
Kula, Alexander J.;Hanberg, Jennifer S.;Testani, Jeffrey M.
背景：急性失代偿性心力衰竭治疗期间收缩压降低（SBP降低）与肾功能恶化密切相关。我们的目的是确定是否SBP减少或滴定的口服神经激素拮抗剂在急性失代偿性心力衰竭治疗产生负面影响利尿和decongesthes.Methods和结果SBP减少连续急性失代偿性心力衰竭入院（n=656）从入院到出院进行了评价。通过一系列参数检查利尿和缓解充血，如利尿效率、液体输出量、血液浓缩和利尿剂剂量。SBP平均下降14.4 ± 19.4 mmHg，77.6%的人群出院时SBP低于入院时。收缩压降低与肾功能恶化密切相关（比值比，1.9; 95%置信区间，1.2-2.9; P=0.004），在调整利尿和缓解充血参数后，这一发现仍然存在（比值比，2.0; 95%置信区间，1.3-3.2; P=0.002）。然而，SBP降低不会对利尿或缓解充血产生负面影响（所有参数的P 0.25）。神经激素拮抗剂的剂量上调发生在>50%的入院患者中，并与血压的适度额外降低（5.6 mmHg）相关。值得注意的是，恶化的肾功能没有增加，利尿效率显着提高与上调的神经激素拮抗剂。结论尽管肾功能恶化率较高，血压降低与恶化的利尿或缓解。此外，在该队列中，口服神经激素拮抗剂的滴定实际上与利尿改善相关。这些结果再次保证，指南推荐的急性失代偿性心力衰竭住院期间长期口服药物滴定可能不会对抗缓解充血的短期目标。
Background Reduction in systolic blood pressure (SBP reduction) during the treatment of acute decompensated heart failure is strongly and independently associated with worsening renal function. Our objective was to determine whether SBP reduction or titration of oral neurohormonal antagonists during acute decompensated heart failure treatment negatively influences diuresis and decongestion.Methods and Results SBP reduction was evaluated from admission to discharge in consecutive acute decompensated heart failure admissions (n=656). Diuresis and decongestion were examined across a range of parameters, such as diuretic efficiency, fluid output, hemoconcentration, and diuretic dose. The average reduction in SBP was 14.419.4 mmHg, and 77.6% of the population had discharge SBP lower than admission. SBP reduction was strongly associated with worsening renal function (odds ratio, 1.9; 95% confidence interval, 1.2-2.9; P=0.004), a finding that persisted after adjusting for parameters of diuresis and decongestion (odds ratio, 2.0; 95% confidence interval, 1.3-3.2; P=0.002). However, SBP reduction did not negatively affect diuresis or decongestion (P0.25 for all parameters). Uptitration of neurohormonal antagonists occurred in >50% of admissions and was associated with a modest additional reduction in blood pressure (5.6 mmHg). Notably, worsening renal function was not increased, and diuretic efficiency was significantly improved with the uptitration of neurohormonal antagonists.Conclusions Despite a higher rate of worsening renal function, blood pressure reduction was not associated with worsening of diuresis or decongestion. Furthermore, titration of oral neurohormonal antagonists was actually associated with improved diuresis in this cohort. These results provide reassurance that the guideline-recommended titration of chronic oral medication during acute decompensated heart failure hospitalization may not be antagonistic to the short-term goal of decongestion.