射血分数保留的心力衰竭患者收缩压目标范围内时间和心血管结局的相关性分析

Correlation between time in target range of systolic blood pressure and cardiovascular outcomes in patients with heart failure with preserved ejection fraction

目的评估射血分数保留的心力衰竭(HFpEF)患者收缩压(SBP)目标范围内的时间(TTR)和心血管结局的相关性。方法选取2021年1月至2022年6月于安徽医科大学附属巢湖医院心血管内科诊治的心力衰竭(心衰,HF)患者121例,分别在基线、第4周、第8周、第4个月测量血压,根据指南推荐的血压目标计算TTR,根据TTR水平将患者分为0~25%,25%~50%,50%~75%,75%~100%四组,比较不同水平TTR的临床特征以及与心血管结局的相关性。结果TTR越高的患者年龄越低,合并症越少,体质指数越低。随访期间共发生23例(19.00%)主要不良心血管事件,17例(14.05%)全因死亡事件,11例(9.09%)心血管死亡事件和13例(10.74%)心衰住院事件。对混杂因素进行调整后,较高的TTR与主要复合终点(HR:0.805,95%CI:0.723~0.838,P<0.001)、全因死亡率(HR:0.799,95%CI:0.781~0.884,P<0.001)、心血管死亡率(HR:0.772,95%CI:0.676~0.882,P<0.001)和心衰住院风险降低(HR:0.836,95%CI:0.734~0.946,P=0.003)显著相关。当患者按不同TTR水平分组时结果相似。亚组分析表明,与高龄患者相比,年龄≤75岁患者的相关性更为显著(P交互=0.028)。结论在HFpEF患者中,SBP的TTR越高,其心血管结局和死亡事件的风险越低,且相关性在≤75岁的患者中更为显著。

Objective To review the correlation between time in target range(TTR)of systolic blood pressure(SBP)and cardiovascular outcomes in patients with heart failure with preserved ejection fraction(HFpEF).Methods HFpEF patients(n=121)were chosen from Department of Cardiovascular Medicine in Chaohu Hospital affliated to Anhui Medical University from Jan.2021 to June 2022.The blood pressure was measured in all patients at baseline,week 4,week 8,and month 4,respectively.TTR was calculated according to the blood pressure target recommended by relative guideline.All patients were divided,according to TTR levels,into TTR 0~25%group,TTR 25%~50%group,TTR 50%~75%group and TTR 75%~100%group.The clinical characteristics were compared among groups,and the correlation between TTR and cardiovascular outcomes was analyzed.Results Patients with higher TTR were younger,and had fewer comorbidities and lower body mass index.During follow-up period,there were 23 cases(19.00%)of major adverse cardiovascular events(MACE),17(14.05%)of all-cause death events,11(9.09%)of cardiovascular death events and 13(10.74%)of hospitalization events due to heart failure.After adjustment for confounding factors,higher TTR was significantly correlated to primary composite endpoint(HR:0.805,95%CI:0.723~0.838,P<0.001),all-cause mortality(HR:0.799,95%Cl:0.781~0.884,P<0.001),cardiovascular mortality(HR:0.772,95%Cl:0.676~0.882,P<0.001),and reduced risk of hospitalization due to heart failure(HR:0.836,95%CI:0.734~0.946,P=0.003).Results were similar when patients were grouped according to different TTR levels.The results of subgroup analysis showed that the correlation was more significant in patients aged≤75 compared with older patients(P=0.028 for interaction).Conclusion The higher the TTR of SBP,the lower the risks of cardiovascular outcomes and death events,and the correlation is more significant in patients aged≤75 in HFpEF patients.