Racial Differences in Incident Heart Failure During Antihypertensive Therapy
Racial Differences in Incident Heart Failure During Antihypertensive Therapy
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DOI：
10.1161/circoutcomes.110.960112
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发表时间：
2011-03-01
影响因子：
6.9
通讯作者：
Devereux, Richard B.
中科院分区：
文献类型：
--
作者：
Okin, Peter M.;Kjeldsen, Sverre E.;Devereux, Richard B.
背景：黑人比非黑人有更高的心力衰竭（HF）患病率，这可能反映了包括高血压在内的HF危险因素的更大负担。虽然HF的发病率是显着较高的黑人在长期随访的年轻人，HF事件的关系，种族在高血压患者接受treatment.Methods和Results-Incident HF进行了评估，在497名黑人和8199名nonblack高血压患者，没有HF的历史随机分配到氯沙坦或阿替洛尔为基础的治疗。在平均4.7 ± 1.1年的随访中，265例患者（3.0%）发生HF住院;黑人患者的5年HF发病率显著高于非黑人患者（7.0%对3.1%，P < 0.001）。在调整随机治疗、年龄、性别、基线ECG上应变模式的存在和其他HF风险因素作为标准协变量，以及事件心肌梗死、治疗中QRS持续时间、舒张压和收缩压、Cornell乘积和左心室肥大（LVH）的Sokolow-Lyon电压标准作为时变协变量的考克斯多变量分析中，黑人与新发HF风险增加130%相关（危害比2.30，95%可信区间1.24 ~ 4.28）。结论：在黑人高血压患者中，新发HF比非黑人高血压患者更常见。在调整了黑人中HF风险因素的较高患病率、治疗效果和治疗中血压以及ECG应变模式和治疗中ECG LVH和QRS持续时间对该人群中新发HF的已知预测值后，黑人新发HF的风险增加持续存在。
Background-Blacks have a higher prevalence of heart failure (HF) than nonblacks, possibly reflecting a greater burden of HF risk factors, including hypertension. Although HF incidence is significantly higher in blacks during long-term follow-up of young adults, the relationship of incident HF to race in hypertensive patients undergoing treatment is unclear.Methods and Results-Incident HF was evaluated in 497 black and 8199 nonblack hypertensive patients with no history of HF randomly assigned to losartan- or atenolol-based treatment. During 4.7 +/- 1.1 years mean follow-up, HF hospitalization occurred in 265 patients (3.0%); 5-year HF incidence was significantly greater in black than nonblack patients (7.0 versus 3.1%, P < 0.001). In Cox multivariate analyses adjusting for randomized treatment, age, sex, the presence of the strain pattern on the baseline ECG, and other HF risk factors treated as standard covariates, and for incident myocardial infarction, in-treatment QRS duration, diastolic and systolic pressure, Cornell product, and Sokolow-Lyon voltage criteria for left ventricular hypertrophy (LVH) treated as time-varying covariates, black race remained associated with a 130% increased risk of developing new HF (hazard ratio 2.30, 95% confidence interval 1.24 to 4.28).Conclusions-Incident HF is substantially more common among black than nonblack hypertensive patients. The increased risk of developing new HF in blacks persists after adjusting for the higher prevalence of HF risk factors in blacks, for treatment effects and in-treatment blood pressure, and for the known predictive value of the ECG strain pattern and in-treatment ECG LVH and QRS duration for incident HF in this population.