Blood pressure and intensive treatment up-titration after acute heart failure hospitalization: Insights from the STRONG-HF trial

被引:5
作者
Pagnesi, Matteo [1 ,2 ]
Vilamajo, Oscar Alberto Gomez [3 ]
Meirino, Alejandro [4 ]
Dumont, Carlos Alberto [5 ]
Mebazaa, Alexandre [6 ,7 ]
Davison, Beth [6 ,8 ,9 ]
Adamo, Marianna [1 ,2 ]
Arrigo, Mattia [10 ]
Barros, Marianela [8 ]
Biegus, Jan [11 ]
Celutkiene, Jelena [12 ]
Cerlinskaite-Bajore, Kamile [12 ]
Chioncel, Ovidiu [13 ]
Cohen-Solal, Alain [6 ,14 ]
Damasceno, Albertino [15 ]
Diaz, Rafael [16 ]
Edwards, Christopher [8 ]
Filippatos, Gerasimos [17 ]
Gayat, Etienne [6 ,7 ]
Kimmoun, Antoine [18 ,19 ,20 ]
Lam, Carolyn S. P. [21 ,22 ,23 ]
Novosadova, Maria [8 ]
Pang, Peter S. [24 ]
Ponikowski, Piotr [11 ]
Saidu, Hadiza [25 ]
Sliwa, Karen [26 ]
Takagi, Koji [8 ]
ter Maaten, Jozine M. [20 ]
Tomasoni, Daniela [1 ,2 ]
Voors, Adriaan A. [20 ]
Cotter, Gad [6 ,8 ,9 ]
Metra, Marco [1 ,2 ,27 ,28 ]
机构
[1] Univ Brescia, Cardiol, ASST Spedali Civili, Brescia, Italy
[2] Univ Brescia, Dept Med & Surg Specialties Radiol Sci & Publ Hlth, Brescia, Italy
[3] Sanat San Martin SA, Cardiol, Venado Tuerto, Argentina
[4] Inst Cardiovasc Rosario, Rosario, Argentina
[5] Hosp Privado Rosario, Cardiol, Rosario, Argentina
[6] Univ Paris Cite, INSERM, UMR S 942 MASCOT, Paris, France
[7] St Louis & Lariboisiere Hosp, AP HP, Dept Anesthesiol & Crit Care & Burn Unit, FHU PROMICE, Paris, France
[8] Momentum Res Inc, Durham, NC USA
[9] Heart Initiat, Durham, NC USA
[10] Stadtspital Zurich, Dept Internal Med, Zurich, Switzerland
[11] Wroclaw Med Univ, Inst Heart Dis, Wroclaw, Poland
[12] Vilnius Univ, Inst Clin Med, Fac Med, Clin Cardiac & Vasc Dis, Vilnius, Lithuania
[13] Univ Med & Pharm Carol Davila, Emergency Inst Cardiovasc Dis Prof CC Iliescu, Bucharest, Romania
[14] Lariboisiere Univ Hosp, APHP Nord, Dept Cardiol, Paris, France
[15] Eduardo Mondlane Univ, Fac Med, Maputo, Mozambique
[16] Inst Cardiovasc Rosario, Estudios Clin Latinoamer, Rosario, Argentina
[17] Natl & Kapodistrian Univ Athens, Attikon Univ Hosp, Sch Med, Athens, Greece
[18] Univ Lorraine, Nancy, France
[19] INSERM, Defaillance Circulatoire Aigue & Chron, Nancy, France
[20] CHRU Nancy, Serv Med Intens & Reanimat Brabois, Vandoeuvre Les Nancy, France
[21] Natl Heart Ctr Singapore, Singapore, Singapore
[22] Duke Natl Univ Singapore, Singapore, Singapore
[23] Univ Groningen, Univ Med Ctr Groningen, Dept Cardiol, Groningen, Netherlands
[24] Indiana Univ Sch Med, Dept Emergency Med, Dept Med, Indianapolis, IN USA
[25] Bayero Univ Kano, Murtala Muhammed Specialist Hosp, Kano, Nigeria
[26] Univ Cape Town, Groote Schuur Hosp, Cape Heart Inst, Dept Med & Cardiol, Cape Town, South Africa
[27] Univ Brescia, Cardiol, ASST Spedali Civili, Piazzale Spedali Civili 1, I-25123 Brescia, Italy
[28] Univ Brescia, Dept Med & Surg Specialties Radiol Sci & Publ Hlth, Piazzale Spedali Civili 1, I-25123 Brescia, Italy
关键词
Heart failure; Acute heart failure; Blood pressure; Medical therapy; Randomized trial; OUTCOMES; ADMISSION; SURVIVAL;
D O I
10.1002/ejhf.3174
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Aims: A high-intensity care (HIC) strategy with rapid guideline-directed medical therapy (GDMT) up-titration and close follow-up visits improved outcomes, compared to usual care (UC), in patients recently hospitalized for acute heart failure (AHF). Hypotension is a major limitation to GDMT implementation. We aimed to assess the impact of baseline systolic blood pressure (SBP) on the effects of HIC versus UC and the role of early SBP changes in STRONG-HF. Methods and results: A total of 1075 patients hospitalized for AHF with SBP >= 100 mmHg were included in STRONG-HF. For the purpose of this post-hoc analysis, patients were stratified by tertiles of baseline SBP (<118, 118-128, and >= 129 mmHg) and, in the HIC arm, by tertiles of changes in SBP from the values measured before discharge to those measured at 1 week after discharge (>= 2 mmHg increase, <= 7 mmHg decrease to <2 mmHg increase, and >= 8 mmHg decrease). The primary endpoint was 180-day heart failure rehospitalization or death. The effect of HIC versus UC on the primary endpoint was independent of baseline SBP evaluated as tertiles (p(interaction) = 0.77) or as a continuous variable (p(interaction) = 0.91). In the HIC arm, patients with increased, stable and decreased SBP at 1 week reached 83.5%, 76.2% and 75.3% of target doses of GDMT at day 90. The risk of the primary endpoint was not significantly different between patients with different SBP changes at 1 week (adjusted p = 0.46). Conclusions: In STRONG-HF, the benefits of HIC versus UC were independent of baseline SBP. Rapid GDMT up-titration was performed also in patients with an early SBP drop, resulting in similar 180-day outcome as compared to patients with stable or increased SBP.
引用
收藏
页码:638 / 651
页数:14
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