β受体阻滞剂对原发性高血压合并冠心病患者临床转归影响的真实世界研究

Effect ofβblockers on clinical outcomes in patients with essential hypertension and coronary artery disease:a real world study

目的探讨β受体阻滞剂治疗对真实世界中原发性高血压合并冠心病患者临床转归的影响。方法连续募集2015年12月至2017年2月在解放军总医院第一医学中心心血管内科住院的原发性高血压合并冠心病的患者615例,其中年龄<65岁346例,年龄≥65岁269例,根据住院及随访5年期间是否全程接受β受体阻滞剂治疗分为β受体阻滞剂治疗组441例(71.71%)和对照组174例。随访5年,观察血压未达标率及主要不良心血管事件(MACE)发生情况。结果β受体阻滞剂治疗组年龄、慢性支气管炎、肾功能不全比例明显低于对照组,陈旧性心肌梗死比例及硝酸酯类药物、他汀类药物、替格瑞洛使用率明显高于对照组(P<0.05,P<0.01)。β受体阻滞剂治疗组5年MACE发生风险和血压未达标率显著低于对照组(9.75%vs 20.11%,HR=0.494,P=0.019;45.12%vs 48.85%;HR=0.091,P=0.044)。β受体阻滞剂治疗组年龄<65岁患者收缩压未达标率明显低于对照组年龄<65岁患者(29.70%vs 33.75%,P=0.034),年龄≥65岁患者5年MACE发生率明显低于对照组年龄≥65岁患者(11.43%vs 28.72%,P=0.014)。结论在原发性高血压合并冠心病患者中,β受体阻滞剂有助于降低MACE及血压未达标的发生风险,其获益受年龄因素的影响。

Objective To investigate the effect ofβ-blocker therapy on the clinical outcomes of patients with essential hypertension combined with coronary artery disease(CAD)in the real world.Methods A total of 615 consecutive patients who were diagnosed with essential hypertension and CAD during hospitalization in Department of Cardiovascular Disease of First Medical Center of Chinese PLA General Hospital from December 2015 to February 2017 were recruited in this study.There were 346 patients at an age of<65 years,and the other 269 were≥65 years old.According to whether receivedβ-blocker therapy during hospitalization and in 5 years of follow-up,they were divided intoβ-blocker group(n=441,accouting for 71.71%)and control group(n=174).During the follow-up,the ratio of uncontrolled blood pressure and incidence of major adverse cardiovascular events(MACE)were observed.Results Theβ-blocker treated patients were younger,and had lower proportions of chronic bronchitis and renal insufficiency,but higher ratios of myocardial infarction history and usages of nitrates,statins and ticagrelor when compared to those who did not receiveβ-blockers(P<0.05,P<0.01).Theβ-blocker therapy could reduce the risk of 5-year MACE occurrence(9.75%vs 20.11%,HR=0.494,P=0.019)and the ratio of uncontrolled hypertentsion(45.12%vs 48.85%,HR=0.091,P=0.044)in the hypertension patients complicated with CAD.Age subgroup analyses showed that,for the patients<65 years old,β-blocker therapy resulted in a significant lower rate of uncontrolled systolic blood pressure when compared to the patients without the treatment(29.70%vs 33.75%,P=0.034);and the treatment also led to an obviously lower incidence of MACE in those≥65 years old than those≥65 years old withoutβ-blocker therapy(11.43%vs 28.72%,P=0.014).ConclusionFor the essential hypertension patients complicated with CAD,β-blocker therapy helps reduce the risk of MACE occurrence and uncontrolled blood pressure,but the benefits are affected by age.