Background

Hypertension is common in patients with heart failure (HF), but less is known about resistant hypertension.

Objectives

This study sought to investigate apparent treatment-resistant hypertension (aTRH) in patients with HF in the SwedeHF (Swedish Heart Failure Registry), across the spectrum of HF phenotypes (heart failure with reduced ejection fraction [HFrEF], heart failure with mildly reduced ejection fraction [HFmrEF], and heart failure with preserved ejection fraction [HFpEF]).

Methods

aTRH was defined as systolic blood pressure ≥140 mm Hg (≥135 mm Hg in diabetes) despite treatment with an angiotensin-converting enzyme inhibitor, angiotensin receptor blocker, or sacubitril-valsartan, as well as a calcium-channel blocker and a diuretic; non–treatment-resistant hypertension (TRH) was defined as systolic blood pressure above these thresholds but not on the 3-drug combination; and normal blood pressure was defined as under these thresholds. In each left ventricular ejection fraction (LVEF) category, patient factors associated with aTRH and non-TRH and outcomes (HF hospitalization and cardiovascular death composite, its components, and all-cause death) according to hypertension category were examined.

Results

Among 46,597 patients, aTRH was present in 2,693 (10%), 1,514 (14%), and 1,450 (17%) patients with HFrEF, HFmrEF, and HFpEF, respectively. Older age, obesity, diabetes, and kidney disease were associated with a greater likelihood of aTRH and non-TRH (vs normal blood pressure). Associations were generally similar irrespective of LVEF category. Compared with normal blood pressure, aTRH was associated with a lower adjusted risk of the composite outcome in HFrEF and HFmrEF (HR: 0.79 [95% CI: 0.74-0.85] and HR: 0.86 [95% CI: 0.77-0.96]) but not in HFpEF (HR: 0.93 [95% CI: 0.84-1.04]).

Conclusions

aTRH was most common in HFpEF and least common in HFrEF. Associated patient characteristics were similar irrespective of LVEF category. aTRH (vs normal blood pressure) was associated with a lower risk of first HF hospitalization or cardiovascular death in HFrEF and HFmrEF but not in HFpEF.

中文翻译：

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瑞典 HF 登记处心力衰竭表型谱中的表观难治性高血压

背景

高血压在心力衰竭 (HF) 患者中很常见，但对顽固性高血压知之甚少。

目标

本研究旨在调查瑞典 HF（瑞典心力衰竭登记处）中 HF 患者的明显难治性高血压 (aTRH)，涵盖各种 HF 表型（射血分数降低的心力衰竭 [HFrEF]、射血分数轻度降低的心力衰竭分数 [HFmrEF] 和保留射血分数的心力衰竭 [HFpEF]）。

方法

aTRH 定义为尽管使用血管紧张素转换酶抑制剂、血管紧张素受体阻滞剂或沙库巴曲缬沙坦以及钙通道阻滞剂和利尿剂治疗，收缩压 ≥140 mm Hg（糖尿病患者≥135 mm Hg）；非难治性高血压 (TRH) 定义为收缩压高于这些阈值，但在 3 种药物组合中不存在；正常血压被定义为低于这些阈值。在每个左心室射血分数 (LVEF) 类别中，根据高血压类别检查与 aTRH 和非 TRH 相关的患者因素以及结局（HF 住院和心血管死亡复合物、其组成部分和全因死亡）。

结果

在 46,597 名患者中，分别有 2,693 名 (10%)、1,514 名 (14%) 和 1,450 名 (17%) 的 HFrEF、HFmrEF 和 HFpEF 患者存在 aTRH。年龄较大、肥胖、糖尿病和肾脏疾病与 aTRH 和非 TRH 的更大可能性相关（与正常血压相比）。无论 LVEF 类别如何，关联通常相似。与正常血压相比，aTRH 与 HFrEF 和 HFmrEF 复合结局的校正风险较低相关（HR：0.79 [95% CI：0.74-0.85] 和 HR：0.86 [95% CI：0.77-0.96]），但不在 HFpEF 中（HR：0.93 [95% CI：0.84-1.04]）。

结论

aTRH 在 HFpEF 中最常见，在 HFrEF 中最不常见。无论 LVEF 类别如何，相关的患者特征都相似。在 HFrEF 和 HFmrEF 中，aTRH（与正常血压相比）与首次 HF 住院或心血管死亡的风险较低相关，但在 HFpEF 中不相关。