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Abstract：
This study assessed the potential role of differential diuretic drugs in preventing incident acute decompensated heart failure (ADHF) in the SPRINT (Systolic Blood Pressure Intervention Trial) study.
SPRINT showed that intensive blood pressure reduction in older patients (50 to 97 years of age) resulted in 36% fewer incident cases of ADHF. However, some investigators have questioned whether this was due merely to intergroup differences in diuretic medications.
Detailed use of medication data prospectively collected throughout the trial were examined.
ADHF events occurred in 173 of 9,361 participants. Diuretic medication increased in both arms from screening to baseline visit (from 45% to 50% in the standard arm; and from 43% to 63% in the intensive arm) and then remained steady. The lowest use of diuretic agents was among participants in the standard arm who never had an ADHF event. Withdrawal of diuretic agents at the baseline visit occurred in 6.1% (n = 284) of participants in the standard arm and 2.3% (n = 107) of participants in the intensive arm. Of these, only 11 developed ADHF during the trial (10 in the standard arm, 1 in the intensive arm), and only 1 occurred ≤1 month after diuretic withdrawal. The benefit of ADHF reduction remained significant even after excluding those 11 participants (hazard ratio [HR]: 0.69; 95% confidence interval [CI]: 0.5 to 0.94; p = 0.02). Most ADHF events occurred in participants who were taking prescribed diuretic therapy at the last visit, prior to the ADHF event. There was limited use of loop (<6%) and potassium-sparing diuretic agents (2%). Diuretic use was not a predictor of ADHF (HR: 0.96; 95% CI: 0.66 to 1.40; p = 0.83).
No evidence was found to suggest that the reduction in new ADHF events in SPRINT was due to differential diuretic use. (Systolic Blood Pressure Intervention Trial [SPRINT]; NCT01206062).
SPRINT showed that intensive blood pressure reduction in older patients (50 to 97 years of age) resulted in 36% fewer incident cases of ADHF. However, some investigators have questioned whether this was due merely to intergroup differences in diuretic medications.
Detailed use of medication data prospectively collected throughout the trial were examined.
ADHF events occurred in 173 of 9,361 participants. Diuretic medication increased in both arms from screening to baseline visit (from 45% to 50% in the standard arm; and from 43% to 63% in the intensive arm) and then remained steady. The lowest use of diuretic agents was among participants in the standard arm who never had an ADHF event. Withdrawal of diuretic agents at the baseline visit occurred in 6.1% (n = 284) of participants in the standard arm and 2.3% (n = 107) of participants in the intensive arm. Of these, only 11 developed ADHF during the trial (10 in the standard arm, 1 in the intensive arm), and only 1 occurred ≤1 month after diuretic withdrawal. The benefit of ADHF reduction remained significant even after excluding those 11 participants (hazard ratio [HR]: 0.69; 95% confidence interval [CI]: 0.5 to 0.94; p = 0.02). Most ADHF events occurred in participants who were taking prescribed diuretic therapy at the last visit, prior to the ADHF event. There was limited use of loop (<6%) and potassium-sparing diuretic agents (2%). Diuretic use was not a predictor of ADHF (HR: 0.96; 95% CI: 0.66 to 1.40; p = 0.83).
No evidence was found to suggest that the reduction in new ADHF events in SPRINT was due to differential diuretic use. (Systolic Blood Pressure Intervention Trial [SPRINT]; NCT01206062).
摘要：
这项研究评估了SPRINT（收缩压干预试验）研究中不同利尿药在预防急性失代偿性心力衰竭（ADHF）中的潜在作用。
SPRINT显示，老年患者（50至97岁）的强化血压降低导致ADHF的发生率减少了36％。然而,一些研究者质疑这是否仅仅是由于两组间利尿药物的差异.
对整个试验中前瞻性收集的药物数据的详细使用进行了检查。
ADHF事件发生在9,361名参与者中的173名。从筛查到基线访问，利尿剂在两组中都增加（标准臂中从45％增加到50％；在密集臂中从43％增加到63％），然后保持稳定。利尿剂使用率最低的是标准组从未发生过ADHF事件的参与者。在基线访视时，有6.1％（n=284）的标准组参与者和2.3％（n=107）的强化组参与者退出了利尿剂。其中,在试验过程中只有11人开发了ADHF(标准臂中有10人，1在密集臂中），仅1例发生于利尿剂停药后≤1个月。即使排除这11名参与者，ADHF减少的益处仍然显着（风险比[HR]：0.69;95％置信区间[CI]：0.5至0.94;p=0.02）。大多数ADHF事件发生在上次就诊时服用处方利尿剂治疗的参与者中，在ADHF事件之前。loop（<6％）和保钾利尿剂（2％）的使用有限。使用利尿剂不是ADHF的预测因子(HR:0.96;95%CI:0.66-1.40;p=0.83)。
没有证据表明SPRINT中新的ADHF事件的减少是由于不同的利尿剂使用。（收缩压干预试验[SPRINT]；NCT01206062）。
SPRINT显示，老年患者（50至97岁）的强化血压降低导致ADHF的发生率减少了36％。然而,一些研究者质疑这是否仅仅是由于两组间利尿药物的差异.
对整个试验中前瞻性收集的药物数据的详细使用进行了检查。
ADHF事件发生在9,361名参与者中的173名。从筛查到基线访问，利尿剂在两组中都增加（标准臂中从45％增加到50％；在密集臂中从43％增加到63％），然后保持稳定。利尿剂使用率最低的是标准组从未发生过ADHF事件的参与者。在基线访视时，有6.1％（n=284）的标准组参与者和2.3％（n=107）的强化组参与者退出了利尿剂。其中,在试验过程中只有11人开发了ADHF(标准臂中有10人，1在密集臂中），仅1例发生于利尿剂停药后≤1个月。即使排除这11名参与者，ADHF减少的益处仍然显着（风险比[HR]：0.69;95％置信区间[CI]：0.5至0.94;p=0.02）。大多数ADHF事件发生在上次就诊时服用处方利尿剂治疗的参与者中，在ADHF事件之前。loop（<6％）和保钾利尿剂（2％）的使用有限。使用利尿剂不是ADHF的预测因子(HR:0.96;95%CI:0.66-1.40;p=0.83)。
没有证据表明SPRINT中新的ADHF事件的减少是由于不同的利尿剂使用。（收缩压干预试验[SPRINT]；NCT01206062）。
