背景:超过90%的发生心力衰竭(HF)的患者具有高血压的流行病学背景。最常见的伴随疾病是2型糖尿病,肥胖,心房颤动,和冠状动脉疾病,所有与高血压密切相关的病症/疾病。
方法:HF结局研究的重点是降低死亡率和预防因HF综合征恶化而住院。所有降低这些HF终点的药物都会降低血压。目前治疗HF的药物是(i)血管紧张素转换酶抑制剂,血管紧张素受体阻滞剂或血管紧张素受体脑啡肽抑制剂,(ii)选定的β受体阻滞剂,(iii)类固醇和非甾体盐皮质激素受体拮抗剂,和(iv)钠-葡萄糖协同转运蛋白2抑制剂。
结果:由于各种原因,这些药物治疗首先在射血分数(HFrEF)降低的HF患者中进行研究.然而,随后,他们已经被调查,正如我们所看到的,记录为对左心室射血分数保留的HF患者有益(LVEF,HFpEF)和大多数高血压病因,在使用已经证明对HFrEF有效的药物进行背景治疗的基础上,部分评估了效果估计。此外,利尿剂在有症状的适应症时使用。
结论:考虑到几乎所有HF患者的抗高血压治疗和/或高血压并发症治疗的总体证据和总体需求,无论LVEF如何,HF的主要药物治疗似乎都是相同的。而不是LVEF引导治疗HF,HF的治疗应根据症状(与液体潴留水平有关),体征(心动过速),严重性(NYHA功能类),以及伴随的疾病和状况。如果耐受性良好,所有HF患者应给予上述所有药物类别。
More than 90% of patients developing heart failure (HF) have an epidemiological background of hypertension. The most frequent concomitant conditions are type 2 diabetes mellitus, obesity, atrial fibrillation, and coronary disease, all disorders/diseases closely related to hypertension.
HF outcome research focuses on decreasing mortality and preventing hospitalization for worsening HF syndrome. All drugs that decrease these HF endpoints lower blood pressure. Current drug treatments for HF are (i) angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, or angiotensin receptor neprilysin inhibitors, (ii) selected beta-blockers, (iii) steroidal and nonsteroidal mineralocorticoid receptor antagonists, and (iv) sodium-glucose cotransporter 2 inhibitors.
For various reasons, these drug treatments were first studied in HF patients with a reduced ejection fraction (HFrEF). However, subsequently, they have been investigated and, as we see it, documented as beneficial in HF patients with a preserved left ventricular ejection fraction (LVEF, HFpEF) and mostly hypertensive etiology, with effect estimates assessed partly on top of background treatment with the drugs already proven effective in HFrEF. Additionally, diuretics are given on symptomatic indications.
Considering the totality of evidence and the overall need for antihypertensive treatment and/or treatment of hypertensive complications in almost all HF patients, the principal drug treatment of HF appears to be the same regardless of LVEF. Rather than LVEF-guided treatment of HF, treatment of HF should be directed by symptoms (related to the level of fluid retention), signs (tachycardia), severity (NYHA functional class), and concomitant diseases and conditions. All HF patients should be given all the drug classes mentioned above if well tolerated.