Objectives

This study assessed the potential role of differential diuretic drugs in preventing incident acute decompensated heart failure (ADHF) in the SPRINT (Systolic Blood Pressure Intervention Trial) study.

Background

SPRINT showed that intensive blood pressure reduction in older patients (50 to 97 years of age) resulted in 36% fewer incident cases of ADHF. However, some investigators have questioned whether this was due merely to intergroup differences in diuretic medications.

Methods

Detailed use of medication data prospectively collected throughout the trial were examined.

Results

ADHF events occurred in 173 of 9,361 participants. Diuretic medication increased in both arms from screening to baseline visit (from 45% to 50% in the standard arm; and from 43% to 63% in the intensive arm) and then remained steady. The lowest use of diuretic agents was among participants in the standard arm who never had an ADHF event. Withdrawal of diuretic agents at the baseline visit occurred in 6.1% (n = 284) of participants in the standard arm and 2.3% (n = 107) of participants in the intensive arm. Of these, only 11 developed ADHF during the trial (10 in the standard arm, 1 in the intensive arm), and only 1 occurred ≤1 month after diuretic withdrawal. The benefit of ADHF reduction remained significant even after excluding those 11 participants (hazard ratio [HR]: 0.69; 95% confidence interval [CI]: 0.5 to 0.94; p = 0.02). Most ADHF events occurred in participants who were taking prescribed diuretic therapy at the last visit, prior to the ADHF event. There was limited use of loop (<6%) and potassium-sparing diuretic agents (2%). Diuretic use was not a predictor of ADHF (HR: 0.96; 95% CI: 0.66 to 1.40; p = 0.83).

Conclusions

No evidence was found to suggest that the reduction in new ADHF events in SPRINT was due to differential diuretic use. (Systolic Blood Pressure Intervention Trial [SPRINT]; NCT01206062).

中文翻译：

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使用强化降压预防老年患者心力衰竭：利尿剂的潜在作用。

 目标

本研究在 SPRINT（收缩压干预试验）研究中评估了不同利尿药物在预防急性失代偿性心力衰竭 (ADHF) 中的潜在作用。

 背景

SPRINT 表明，老年患者（50 至 97 岁）的强化血压降低可使 ADHF 病例减少 36%。然而，一些研究人员质疑这是否仅仅是由于利尿药物的组间差异所致。

 方法

对整个试验期间前瞻性收集的药物数据的详细使用进行了检查。

 结果

9,361 名参与者中，有 173 人发生 ADHF 事件。从筛查到基线访视，双臂的利尿药物使用量均有所增加（标准臂从 45% 增至 50%；强化臂从 43% 增至 63%），然后保持稳定。利尿剂使用率最低的是标准组中从未发生过 ADHF 事件的参与者。标准组中 6.1% (n = 284) 的参与者和强化组中 2.3% (n = 107) 的参与者在基线访视时停用利尿剂。其中，试验期间只有 11 例出现 ADHF（标准组 10 例，强化组 1 例），只有 1 例在利尿剂停药后 ≤1 个月内发生。即使排除这 11 名参与者，ADHF 减少的益处仍然显着（风险比 [HR]：0.69；95% 置信区间 [CI]：0.5 至 0.94；p = 0.02）。大多数 ADHF 事件发生在 ADHF 事件之前最后一次就诊时正在接受处方利尿治疗的参与者中。袢（<6%）和保钾利尿剂（2%）的使用有限。利尿剂的使用不是 ADHF 的预测因素（HR：0.96；95% CI：0.66 至 1.40；p = 0.83）。

 结论

没有发现证据表明 SPRINT 中新发 ADHF 事件的减少是由于差异化利尿剂的使用。 （收缩压干预试验 [SPRINT]；NCT01206062）。