JACC: Heart Failure ( IF 10.3 ) Pub Date : 2021-10-06 , DOI: 10.1016/j.jchf.2021.07.001 Yuya Matsue 1 , Iziah E Sama 2 , Douwe Postmus 2 , Marco Metra 3 , Barry H Greenberg 4 , Gad Cotter 5 , Beth A Davison 5 , G Michael Felker 6 , Gerasimos Filippatos 7 , Peter Pang 8 , Piotr Ponikowski 9 , Thomas Severin 10 , Claudio Gimpelewicz 10 , Adriaan A Voors 2 , John R Teerlink 11
|
Objectives
The aim of this study was to investigate the association between systolic blood pressure (SBP) drop, worsening renal function (WRF), and prognosis in patients with acute heart failure (AHF).
Background
A large drop in SBP early after hospital admission for AHF might be associated with increased risk for WRF and prognosis. However, there is a paucity of data regarding the interaction between WRF and a drop in SBP on clinical outcomes.
Methods
A post hoc analysis among 6,544 patients with AHF enrolled in the RELAX-AHF-2 (Relaxin in Acute Heart Failure-2) trial was performed. Blood pressure was uniformly and repetitively measured. Peak SBP drop was defined as the difference between baseline SBP and lowest SBP documented during the first 48 hours. WRF was defined by an increase in serum creatinine of ≥0.3 mg/dL from baseline to day 5.
Results
Peak SBP drop was independently associated with a higher risk for WRF (HR: 1.11 per 10 mm Hg SBP drop; P < 0.001), 5-day worsening heart failure (HR: 1.12 per 10 mm Hg SBP drop; P = 0.006), and 180-day cardiovascular death (HR: 1.09 per 10 mm Hg SBP drop; P = 0.026) after adjustment for potential confounders including baseline SBP. There was no interaction between the prognostic value of early SBP drop according to the presence or absence of WRF.
Conclusions
In patients hospitalized for AHF, a greater early drop in SBP was associated with a higher incidence of WRF, worsening heart failure, and an increased risk for 180-day cardiovascular death. However, the association between SBP drop and prognosis was not influenced by WRF. (Efficacy, Safety and Tolerability of Serelaxin When Added to Standard Therapy in AHF [RELAX-AHF-2]; NCT01870778)
中文翻译：
早期血压下降和肾功能与急性心力衰竭预后的关系
目标
本研究的目的是调查收缩压 (SBP) 下降、肾功能恶化 (WRF) 和急性心力衰竭 (AHF) 患者预后之间的关系。
背景
AHF 入院后早期 SBP 大幅下降可能与 WRF 和预后风险增加有关。然而，关于 WRF 与 SBP 下降对临床结果的相互作用的数据很少。
方法
对参加 RELAX-AHF-2（Relaxin in Acute Heart Failure-2）试验的 6,544 名 AHF 患者进行了事后分析。血压被均匀地重复测量。峰值 SBP 下降定义为最初 48 小时内记录的基线 SBP 和最低 SBP 之间的差异。WRF 定义为从基线到第 5 天血清肌酐增加≥0.3 mg/dL。
结果
峰值 SBP 下降与 WRF 的较高风险独立相关（HR：每 10 mm Hg SBP 下降 1.11；P < 0.001），5 天心力衰竭恶化（HR：每 10 mm Hg SBP 下降 1.12；P = 0.006），在调整包括基线 SBP 在内的潜在混杂因素后，180 天心血管死亡（HR：每 10 mm Hg SBP 下降 1.09；P = 0.026）。根据 WRF 的存在与否，早期 SBP 下降的预后价值之间没有相互作用。
结论
在因 AHF 住院的患者中，SBP 早期下降幅度较大与 WRF 发生率较高、心力衰竭恶化和 180 天心血管死亡风险增加有关。然而，SBP 下降与预后之间的关联不受 WRF 的影响。（在 AHF 标准治疗中添加 Serelaxin 的疗效、安全性和耐受性 [RELAX-AHF-2]；NCT01870778）
京公网安备 11010802027423号