Blood pressure reactivity to psychological stress is associated with clinical outcomes in patients with heart failure.
Blood pressure reactivity to psychological stress is associated with clinical outcomes in patients with heart failure.
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DOI：
10.1016/j.ahj.2017.07.003
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发表时间：
2017-09
影响因子：
4.8
通讯作者：
Hinderliter AL
中科院分区：
文献类型：
--
作者：
Sherwood A;Hill LK;Blumenthal JA;Adams KF Jr;Paine NJ;Koch GG;O'Connor CM;Johnson KS;Hinderliter AL
心血管(CV)对心理应激的反应与心血管疾病(CVD)的发生和加重有关。尽管高心血管反应性传统上被认为传递了更大的心血管疾病风险，但反应性和临床结果之间的关系是不一致的，可能取决于研究中的患者群体。本研究检测了心力衰竭(HF)患者的心血管反应性及其与长期临床结果的潜在关联。199名确诊为心力衰竭的门诊患者，射血分数≤为40%，接受了血压(BP)和心率对实验室模拟公开演讲应激源的反应性评估。COX比例风险回归模型被用来检验在5年的中位随访期内，在死亡或心血管住院的联合终点上，血压和心率反应性之间的前瞻性关联。收缩压(SBP)和舒张压(DBP)反应性都被量化为连续变量，在控制了包括心力衰竭严重程度、病因和年龄在内的既定危险因素后，两者与死亡或心血管住院的风险呈负相关(p‘s<；.01)。在相似的模型中，心率反应性与结果无关(p=0.12)。在具有三级反应性的模型中，与中等反应性相比，高SBP反应性与较低的风险相关(危险比=.498，95%CI[.335，.742]，p=.001)；而低SBP反应性与中等反应性没有区别。对于DBP，高反应性与中等反应性相比风险较低(HR=.767，95%CI[.515，1.14]，p=.193)，而低反应性与较高风险相关(HR=1.49，95%CI[1.027，2.155]，p=.0359)。未发现心率反应性与结果之间的关系。对于射血分数降低的心衰患者，基于实验室的心理挑战引起的血压显著升高与不良心血管事件的风险降低相关，这可能是一种新的和独特的左心室收缩储备的标志，并伴随着更有利的长期预后。
Cardiovascular (CV) reactivity to psychological stress has been implicated in the development and exacerbation of cardiovascular disease (CVD). Although high CV reactivity traditionally is thought to convey greater risk of CVD, the relationship between reactivity and clinical outcomes is inconsistent, and may depend on the patient population under investigation. The present study examined CV reactivity in patients with heart failure (HF) and its potential association with long-term clinical outcomes. 199 outpatients diagnosed with HF, with ejection fraction ≤40%, underwent an evaluation of blood pressure (BP) and heart rate reactivity to a laboratory-based simulated public-speaking stressor. Cox proportional hazards regression models were used to examine the prospective association between BP and heart rate reactivity on a combined endpoint of death or CV hospitalization over a 5-year median follow-up period. Both systolic blood pressure (SBP) and diastolic blood pressure (DBP) reactivity, quantified as continuous variables, were inversely related to risk of death or CV hospitalization (p’s<.01) after controlling for established risk factors, including HF disease severity, etiology, and age. In similar models, heart rate reactivity was unrelated to outcome (p=0.12). In models with tertiles of reactivity, high SBP reactivity, compared to intermediate SBP reactivity, was associated with lower risk (Hazard Ratio = .498, 95% CI [.335, .742], p =.001); while low SBP reactivity did not differ from intermediate reactivity. For DBP, high reactivity was marginally associated with lower risk compared to intermediate DBP reactivity (HR = .767, 95% CI [.515, 1.14], p =.193), while low DBP reactivity was associated with greater risk (HR = 1.49, 95% CI [1.027, 2.155], p =.0359). No relationship of heart rate reactivity to outcome was identified. For HF patients with reduced ejection fraction, a robust increase in BP evoked by a laboratory-based psychological challenge was associated with lower risk for adverse CVD events, and may be a novel and unique marker of left ventricular systolic reserve that is accompanied by a more favorable long-term prognosis.
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影响因子：
158.5
作者：
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通讯作者：
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影响因子：
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