Quantifying the paradoxical effect of higher systolic blood pressure on mortality in chronic heart failure
Quantifying the paradoxical effect of higher systolic blood pressure on mortality in chronic heart failure
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DOI：
10.1136/hrt.2007.134973
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发表时间：
2009-01-01
期刊：
影响因子：
5.7
通讯作者：
Francis, D. P.
中科院分区：
文献类型：
--
作者：
Raphael, C. E.;Whinnett, Z. I.;Francis, D. P.
背景：虽然高血压通常被认为是心脏病患者风险评估的不良预后标志，但它与慢性心力衰竭(CHF)风险的关系可能不同。目的：系统地审查已发表的关于慢性心力衰竭(CHF)血压与死亡率关系的报道。方法：利用Medline和Embase来确定在稳定的CHF人群中给出收缩压风险或相对风险比的研究。结果：10项研究符合纳入标准，总人数8088人，随访29222人年。所有研究都表明，较高的收缩压(SBP)是CHF有利的预后指标，而普通人群则是预后较差的指标。在心力衰竭人群中，与SBP升高10 mm Hg相关的死亡率下降13.0%(95%可信区间10.6%至15.4%)。这与病因学、ACE抑制剂或β受体阻滞剂的使用无关。结论：SBP是一个易于测量的连续变量，与CHF人群中的死亡率有非常一致的关系。这一简单变量在CHF患者门诊评估中的潜力不应被忽视。这种信息的一个可能的应用是心脏再同步设备的优化。
Background: Although higher blood pressures are generally recognised to be an adverse prognostic marker in risk assessment of cardiology patients, its relationship to risk in chronic heart failure ( CHF) may be different.Objective: To examine systematically published reports on the relationship between blood pressure and mortality in CHF.Methods: Medline and Embase were used to identify studies that gave a hazard or relative risk ratio for systolic blood pressure in a stable population with CHF. Included studies were analysed to obtain a unified hazard ratio and quantify the degree of confidence.Results: 10 studies met the inclusion criteria, giving a total population of 8088, with 29 222 person-years of follow-up. All studies showed that a higher systolic blood pressure ( SBP) was a favourable prognostic marker in CHF, in contrast to the general population where it is an indicator of poorer prognosis. The decrease in mortality rates associated with a 10 mm Hg higher SBP was 13.0% ( 95% CI 10.6% to 15.4%) in the heart failure population. This was not related to aetiology, ACE inhibitor or beta blocker use.Conclusion: SBP is an easily measured, continuous variable that has a remarkably consistent relationship with mortality within the CHF population. The potential of this simple variable in outpatient assessment of patients with CHF should not be neglected. One possible application of this information is in the optimisation of cardiac resynchronisation devices.