Early drop in systolic blood pressure is associated with poor diuretic response and prognosis in patients with acute heart failure
Early drop in systolic blood pressure is associated with poor diuretic response and prognosis in patients with acute heart failure
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DOI：
10.1093/ehjacc/zuac105
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发表时间：
2022-09-05
影响因子：
4.1
通讯作者：
Minamino, Tohru
中科院分区：
文献类型：
--
作者：
Dotare, Taishi;Maeda, Daichi;Minamino, Tohru
虽然在急性心力衰竭（AHF）期间收缩压（SBP）过度下降会对预后产生负面影响，但SBP变化与利尿反应（DR）之间的关系尚不清楚。我们的目的是澄清早期下降的SBP和DR/预后AHF.Methods和结果的患者之间的关联这是一个子分析的REALITY-AHF研究，登记的AHF患者通过急诊科（ED）入院。早期SBP下降定义为基线SBP与住院前48小时内最低值之间的差异。DR定义为每40 mg静脉注射呋塞米达到的尿量。分别于入院时、入院后90 min、6 h、24 h和48 h测量SBP。根据中位SBP下降和DR将患者分为4组：SBP下降较大/DR较差（n = 322）、SBP下降较小/DR较差（n = 409）、SBP下降较大/DR良好（n = 419）和SBP下降较小/DR良好（n = 314）。该研究包括1，464名患者。收缩压下降幅度较大/DR较差与基线收缩压和血管扩张剂使用较高相关。多变量线性回归分析显示，调整潜在协变量后，收缩压下降幅度越大，DR越差。考克斯比例风险分析表明，更大的SBP下降/差DR与1年死亡率独立相关。结论AHF患者住院前48 h内收缩压早期下降与DR不良和1年死亡率相关。
Aims Although an excessive drop in systolic blood pressure (SBP) during acute heart failure (AHF) negatively impacts prognosis, the association between changes in SBP and the diuretic response (DR) is unclear. We aimed to clarify the association between an early drop in SBP and DR/prognosis in patients with AHF.Methods and results This was a sub-analysis of the REALITY-AHF study, which registered patients with AHF admitted through emergency departments (EDs). An early SBP drop was defined as the difference between baseline SBP and the lowest value during the first 48 h of hospitalization. DR was defined as the urine output achieved per 40 mg of intravenous furosemide administered. SBP was measured on admission, at 90 min, and 6, 24, and 48 h after admission. Patients were divided into four groups according to their median SBP drop and DR: greater SBP drop/poor DR (n = 322), smaller SBP drop/poor DR (n = 409), greater SBP drop/good DR (n = 419), and smaller SBP drop/good DR (n = 314). The study included 1,464 patients. A greater SBP drop/poor DR was associated with higher baseline SBP and vasodilator use. Multivariable linear regression analysis showed that a greater drop in SBP was associated with poorer DR following adjustment for potential covariates. Cox proportional hazards analysis demonstrated that a greater SBP drop/poor DR was independently associated with 1-year mortality. Both SBP and DR changes were independently associated with prognosis.Conclusion An early drop in SBP during the first 48 h of hospitalization was associated with poor DR and 1-year mortality in patients with AHF.