在心力衰竭中静脉血压和脉压:对4项试验的组合参与者级分析
Henri Lu1, Toru Kondo2, Brian L Claggett3
1Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA; Division of Cardiology, Lausanne University Hospital (CHUV), University of Lausanne (UNIL), Lausanne, Vaud, Switzerland.
Journal of the American College of Cardiology
|January 2, 2025
概括
对于心力衰竭患者,轻微减少或保留喷射分数 (HFmrEF/HFpEF),静脉血压 (SBP) 为120-130 mmHg,脉冲压 (PP) 为50-60 mmHg时心血管风险最低. 较高的SBP和PP水平与风险增加有关.
科学领域:
- 心脏病学 心脏病学
- 临床试验 临床试验
- 心脏衰竭研究研究
背景情况:
- 高血压在心力衰竭中普遍存在,其中喷射分数略有减少或保留 (HFmrEF/HFpEF).
- 目前的指导方针建议将系统血压 (SBP) 定位在130mmHg以下,但支持数据有限.
- 脉压 (PP) 是主动脉硬度的指标,已与心血管事件有关,但其HFpEF的预后值需要进一步研究.
研究的目的:
- 调查基线SBP和PP对HFmrEF或HFpEF患者心血管结局的影响.
- 分析连续SBP和PP与心血管事件的主要终点之间的关系.
- 评估不同SBP类别和PP四分位数的预后意义.
主要方法:
- 来自四个全球随机临床试验的数据汇总:I-PRESERVE,TOPCAT-Americas,PARAGON-HF,以及DELIVER. 这四个临床试验的数据汇总.
- 对16,950名心力衰竭和排泄率≥40%或≥45%的患者的分析.
- 限制性立方线用于建模连续基线SBP和PP与主要终点 (心力衰竭住院治疗或心血管死亡) 之间的关系.
主要成果:
- SBP和心血管风险之间的关系是J型,观察到的最低风险在120-130 mmHg之间.
- 对于PP,也发现了类似的J形模式,风险最低在50-60mmHg之间.
- 较高的SBP (≥140 mmHg) 和PP独立地与初级结局的风险增加有关,而较高的PP无论SBP如何都表明更大的心血管风险.
结论:
- 一项对16900多名患有HFmrEF/HFpEF的患者的大型综合分析显示,SBP,PP和心血管风险之间存在J形关联.
- 降低心血管风险的最佳SBP水平在120-130mmHg之间被确定.
- 降低心血管风险的最佳PP水平在50-60mmHg之间被确定.
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