Abstract：
BACKGROUND: Hypertension (HTN) is a co-morbidity that is commonly associated with heart failure with preserved ejection fraction (HFpEF). However, it remains unclear whether treatment of hypertension in HFpEF patients is associated with improved cardiovascular outcomes.
OBJECTIVE: The purpose of this meta-analysis is to evaluate the association of anti-hypertensive medical therapy with cardiovascular outcomes in patients with HFpEF.
METHODS: We performed a database search for studies reporting on the association of anti-hypertensive medications with cardiovascular outcomes and safety endpoints in patients with HFpEF. The databases searched include OVID Medline, Web of Science, and Embase. The primary endpoint was all-cause mortality. Secondary endpoints include cardiovascular (CV) mortality, worsening heart failure (HF), CV hospitalization, composite major adverse cardiovascular events (MACE), hyperkalemia, worsening renal function, and hypotension.
RESULTS: A total of 12 studies with 14062 HFpEF participants (7010 treated with medical therapy versus 7052 treated with placebo) met inclusion criteria. Use of anti-hypertensive medications was not associated with lower all-cause mortality, CV mortality or CV hospitalization compared to treatment with placebo (OR 1.02, 95% CI 0.77-1.35; p = 0.9, OR 0.88, 95% CI 0.73-1.06; p = 0.19, OR 0.99, 95% CI 0.87-1.12; p = 0.83, OR 0.90, 95% CI 0.79-1.03; p = 0.11). Anti-hypertensive medications were not associated with lower risk of subsequent acute myocardial infarction (AMI) (OR 0.53, 95% CI 0.07-3.73; p = 0.5). Use of anti-hypertensive medications was associated with a statistically significant lower risk of MACE (OR 0.90, 95% CI 0.83-0.98; p = 0.02).
CONCLUSIONS: While treatment with anti-hypertensive medications was not associated with lower risk of all-cause mortality, their use may be associated with reduce risk of adverse cardiovascular outcomes in patients with HFpEF regardless of whether they have HTN. Additional high quality studies are required to clarify this association and determine the effect based on specific classes of medications.
OBJECTIVE: The purpose of this meta-analysis is to evaluate the association of anti-hypertensive medical therapy with cardiovascular outcomes in patients with HFpEF.
METHODS: We performed a database search for studies reporting on the association of anti-hypertensive medications with cardiovascular outcomes and safety endpoints in patients with HFpEF. The databases searched include OVID Medline, Web of Science, and Embase. The primary endpoint was all-cause mortality. Secondary endpoints include cardiovascular (CV) mortality, worsening heart failure (HF), CV hospitalization, composite major adverse cardiovascular events (MACE), hyperkalemia, worsening renal function, and hypotension.
RESULTS: A total of 12 studies with 14062 HFpEF participants (7010 treated with medical therapy versus 7052 treated with placebo) met inclusion criteria. Use of anti-hypertensive medications was not associated with lower all-cause mortality, CV mortality or CV hospitalization compared to treatment with placebo (OR 1.02, 95% CI 0.77-1.35; p = 0.9, OR 0.88, 95% CI 0.73-1.06; p = 0.19, OR 0.99, 95% CI 0.87-1.12; p = 0.83, OR 0.90, 95% CI 0.79-1.03; p = 0.11). Anti-hypertensive medications were not associated with lower risk of subsequent acute myocardial infarction (AMI) (OR 0.53, 95% CI 0.07-3.73; p = 0.5). Use of anti-hypertensive medications was associated with a statistically significant lower risk of MACE (OR 0.90, 95% CI 0.83-0.98; p = 0.02).
CONCLUSIONS: While treatment with anti-hypertensive medications was not associated with lower risk of all-cause mortality, their use may be associated with reduce risk of adverse cardiovascular outcomes in patients with HFpEF regardless of whether they have HTN. Additional high quality studies are required to clarify this association and determine the effect based on specific classes of medications.
摘要：
背景：高血压（HTN）是一种合并症，通常与射血分数保留的心力衰竭（HFpEF）相关。然而,目前尚不清楚治疗HFpEF患者的高血压是否与改善心血管结局相关.
目的：本荟萃分析的目的是评估HFpEF患者抗高血压药物治疗与心血管预后的关系。
方法：我们进行了数据库搜索，研究报告了抗高血压药物与HFpEF患者心血管结局和安全性终点的相关性。搜索的数据库包括OVIDMedline，WebofScience,和Embase。主要终点是全因死亡率。次要终点包括心血管（CV）死亡率，恶化的心力衰竭（HF），CV住院，复合主要不良心血管事件（MACE），高钾血症,肾功能恶化，和低血压。
结果：共有12项研究，有14062例HFpEF参与者（7010例接受药物治疗，而7052例接受安慰剂治疗）符合纳入标准。使用抗高血压药物与降低全因死亡率无关，与安慰剂治疗相比，CV死亡率或CV住院率（OR1.02，95％CI0.77-1.35；p=0.9，OR0.88，95％CI0.73-1.06；p=0.19，OR0.99，95％CI0.87-1.12；p=0.83，OR0.90，95％CI0.79-1.03；p=0.11）。抗高血压药物与随后的急性心肌梗死（AMI）的风险较低无关（OR0.53，95％CI0.07-3.73；p=0.5）。使用抗高血压药物与具有统计学意义的较低的MACE风险相关（OR0.90，95％CI0.83-0.98；p=0.02）。
结论：虽然抗高血压药物治疗与降低全因死亡风险无关，在HFpEF患者中,无论是否患有HTN,它们的使用可能与降低不良心血管结局的风险相关.需要额外的高质量研究来澄清这种关联，并根据特定类别的药物确定效果。
目的：本荟萃分析的目的是评估HFpEF患者抗高血压药物治疗与心血管预后的关系。
方法：我们进行了数据库搜索，研究报告了抗高血压药物与HFpEF患者心血管结局和安全性终点的相关性。搜索的数据库包括OVIDMedline，WebofScience,和Embase。主要终点是全因死亡率。次要终点包括心血管（CV）死亡率，恶化的心力衰竭（HF），CV住院，复合主要不良心血管事件（MACE），高钾血症,肾功能恶化，和低血压。
结果：共有12项研究，有14062例HFpEF参与者（7010例接受药物治疗，而7052例接受安慰剂治疗）符合纳入标准。使用抗高血压药物与降低全因死亡率无关，与安慰剂治疗相比，CV死亡率或CV住院率（OR1.02，95％CI0.77-1.35；p=0.9，OR0.88，95％CI0.73-1.06；p=0.19，OR0.99，95％CI0.87-1.12；p=0.83，OR0.90，95％CI0.79-1.03；p=0.11）。抗高血压药物与随后的急性心肌梗死（AMI）的风险较低无关（OR0.53，95％CI0.07-3.73；p=0.5）。使用抗高血压药物与具有统计学意义的较低的MACE风险相关（OR0.90，95％CI0.83-0.98；p=0.02）。
结论：虽然抗高血压药物治疗与降低全因死亡风险无关，在HFpEF患者中,无论是否患有HTN,它们的使用可能与降低不良心血管结局的风险相关.需要额外的高质量研究来澄清这种关联，并根据特定类别的药物确定效果。
