Time in Target Range for Systolic Blood Pressure and Cardiovascular Outcomes in Patients With Heart Failure With Preserved Ejection Fraction.
Time in Target Range for Systolic Blood Pressure and Cardiovascular Outcomes in Patients With Heart Failure With Preserved Ejection Fraction.
复制标题
射血分数保留的心力衰竭患者收缩压达到目标范围的时间和心血管结局
DOI：
10.1161/jaha.121.022765
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发表时间：
2022-04-05
影响因子：
5.4
通讯作者：
Liao, Xinxue
中科院分区：
文献类型：
--
作者：
Huang, Rihua;Lin, Yifen;Liu, Menghui;Xiong, Zhenyu;Zhang, Shaozhao;Zhong, Xiangbin;Ye, Xiaomin;Huang, Yiquan;Zhuang, Xiaodong;Liao, Xinxue
在射血分数正常的心力衰竭患者中，血压控制和临床结局之间的关系尚不清楚。收缩压过高或过低均与预后不良有关。本研究旨在评估射血分数正常的心力衰竭患者SBP目标范围内的时间与不良临床事件之间的相关性。本研究是TOPCAT（用醛固酮拮抗剂治疗保留心功能的心力衰竭）试验的次要分析，该试验是一项随机临床试验，比较了螺内酯在射血分数保留的心力衰竭患者中的疗效和安全性。使用线性插值计算目标范围内的时间（TTR），SBP的目标范围定义为110 - 130 mm Hg。使用多变量考克斯回归来估计TTR与不良结局之间的相关性，以校正多个混杂因素。TTR较高的参与者更年轻，更可能是白色，合并症较少，体重指数较低。调整多个协变量（包括平均SBP）后，1-SD增量（38.3%）的TTR与主要复合终点的风险降低显著相关（风险比[HR]，0.81 [0.73 - 0.90]），以及全因死亡风险较低（HR，0.81 [0.73 - 0.90]）、心血管死亡（HR，0.78 [0.68 - 0.90]）和心力衰竭住院（HR，0.85 [0.74 - 0.97]）。当参与者按TTR组分类时，结果相似。亚组分析显示，青年人的相关性比老年人更显著（P交互作用= 0.028）。在射血分数正常的心力衰竭患者中，SBP目标范围内的更长时间与血压水平以外的心血管结局和死亡事件风险降低具有统计学相关性，尤其是在年轻患者中。
The association between blood pressure control and clinical outcomes is unclear among patients with heart failure with preserved ejection fraction. Both too high and too low of systolic blood pressure (SBP) have been reported to be related to poor clinical prognosis. This study aimed to assess the association between time in SBP target range and adverse clinical events among patients with heart failure with preserved ejection fraction. This study was a secondary analysis of the TOPCAT (Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist) trial, a randomized clinical trial that compared the efficacy and safety of spironolactone in patients with heart failure with preserved ejection fraction. Time in target range (TTR) was calculated using linear interpolation, with the target range of SBP defined as 110 to 130 mm Hg. The association between TTR with adverse outcomes was estimated using multivariable Cox regression to adjust for multiple confounders. Participants with greater TTR were younger, more likely to be White, had less comorbidities, and lower body mass index. After adjusting for multiple covariates including mean SBP, 1‐SD increment (38.3%) of TTR was significantly associated with a decreased risk of primary composite end point (hazard ratio [HR], 0.81 [0.73–0.90]), as well as a lower risk of all‐cause mortality (HR, 0.81 [0.73–0.90]), cardiovascular death (HR, 0.78 [0.68–0.90]), and heart failure hospitalization (HR, 0.85 [0.74–0.97]). Results were similar when participants were categorized by TTR groups. Subgroup analyses showed that the associations were more significant in young people than in the old (P interaction=0.028). In patients with heart failure with preserved ejection fraction, greater time in SBP target range was statistically associated with a decreased risk of cardiovascular outcomes and mortality events beyond blood pressure level, especially among younger patients.