Mesh : Humans Heart Failure / physiopathology drug therapy mortality Male Female Aged Prognosis Hypotension / physiopathology Blood Pressure Acute Disease Middle Aged Aged, 80 and over Stroke Volume Angiotensin-Converting Enzyme Inhibitors / therapeutic use Adrenergic beta-Antagonists / therapeutic use Angiotensin Receptor Antagonists / therapeutic use

来  源:   DOI:10.1038/s41598-024-66219-2   PDF(Pubmed)

Abstract:
Low blood pressure (BP) is associated with poor outcomes in patients with heart failure (HF). We investigated the influence of initial BP on the prognosis of HF patients at admission, and prescribing patterns of HF medications, such as angiotensin-converting enzyme inhibitors (ACEi), angiotensin receptor blockers (ARB), and beta-blockers (BB). Data were sourced from a multicentre cohort of patients admitted for acute HF. Patients were grouped into heart failure reduced ejection fraction (HFrEF) and HF mildly reduced/preserved ejection fraction (HFmrEF/HFpEF) groups. Initial systolic and diastolic BPs were categorized into specific ranges. Among 2778 patients, those with HFrEF were prescribed ACEi, ARB, or BB at discharge, regardless of their initial BP. However, medication use in HFmrEF/HFpEF patients tended to decrease as BP decreased. Lower initial BP in HFrEF patients correlated with an increased incidence of all-cause death and composite clinical events, including HF readmission or all-cause death. However, no significant differences in clinical outcomes were observed in HFmrEF/HFpEF patients according to BP. Initial systolic (< 120 mmHg) and diastolic (< 80 mmHg) BPs were independently associated with a 1.81-fold (odds ratio [OR] 1.81, 95% confidence interval [CI] 1.349-2.417, p < 0.001) and 2.24-fold (OR 2.24, 95% CI 1.645-3.053, p < 0.001) increased risk of long-term mortality in HFrEF patients, respectively. In conclusion, low initial BP in HFrEF patients correlated with adverse clinical outcomes, and BP < 120/80 mmHg independently increased mortality. However, this relationship was not observed in HFmrEF/HFpEF patients.
摘要:
低血压(BP)与心力衰竭(HF)患者的不良预后相关。我们调查了初始血压对HF患者入院时预后的影响,和HF药物的处方模式,如血管紧张素转换酶抑制剂(ACEi),血管紧张素受体阻滞剂(ARB),和β受体阻滞剂(BB)。数据来自急性HF患者的多中心队列。将患者分为心力衰竭射血分数降低(HFrEF)和HF轻度射血分数降低/保留(HFmrEF/HFpEF)组。初始收缩期和舒张期BP分为特定范围。在2778名患者中,那些有HFrEF的人被开了ACEi,ARB,或BB在放电时,不管他们最初的BP。然而,HFmrEF/HFpEF患者的药物使用随着BP的降低而趋于减少.HFrEF患者的初始血压较低与全因死亡和复合临床事件的发生率增加相关。包括HF再入院或全因死亡。然而,根据BP,HFmrEF/HFpEF患者的临床结局无显著差异.初始收缩压(<120mmHg)和舒张压(<80mmHg)BP与HFrEF患者长期死亡风险的1.81倍(比值比[OR]1.81,95%置信区间[CI]1.349-2.417,p<0.001)和2.24倍(OR2.24,95%CI1.645-3.053,p<0.001)独立相关,分别。总之,HFrEF患者的低初始血压与不良临床结局相关,和BP<120/80mmHg独立增加死亡率。然而,在HFmrEF/HFpEF患者中未观察到这种关系.
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