Effect of dapagliflozin according to baseline systolic blood pressure in the Dapagliflozin and Prevention of Adverse Outcomes in Heart Failure trial (DAPA-HF)

被引：111

作者：

Serenelli, Matteo ^{[1
,2
]}

Boehm, Michael ^{[3
]}

Inzucchi, Silvio E. ^{[4
]}

Kober, Lars ^{[5
]}

Kosiborod, Mikhail N. ^{[6
,7
]}

Martinez, Felipe A. ^{[8
]}

Ponikowski, Piotr ^{[9
]}

Sabatine, Marc S. ^{[10
]}

Solomon, Scott D. ^{[10
]}

DeMets, David L. ^{[11
]}

Bengtsson, Olof ^{[12
]}

Sjostrand, Mikaela ^{[12
]}

Langkilde, Anna Maria ^{[12
]}

Anand, Inder S. ^{[13
]}

Chiang, Chern-En ^{[14
,15
,16
]}

Chopra, Vijay K. ^{[17
]}

de Boer, Rudolf A. ^{[18
,19
]}

Diez, Mirta ^{[20
]}

Dukat, Andrej ^{[21
]}

Ge, Junbo ^{[22
,23
]}

Howlett, Jonathan G. ^{[24
]}

Katova, Tzvetana ^{[25
]}

Kitakaze, Masafumi ^{[26
]}

Ljungman, Charlotta E. A. ^{[27
]}

Verma, Subodh ^{[28
]}

Docherty, Kieran F. ^{[1
]}

Jhund, Pardeep S. ^{[1
]}

McMurray, John J., V ^{[1
]}

机构：

[1] Univ Glasgow, British Heart Fdn, Cardiovasc Res Ctr, 126 Univ Pl, Glasgow G12 8TA, Lanark, Scotland

[2] Azienda Osped Univ Ferrara, Cardiovasc Inst, Cona, Italy

[3] Univ Saarland, Univ Klinikum Saarlandes, Klin Innere Med 3, Homburg, Germany

[4] Yale Univ, Sch Med, Sect Endocrinol, New Haven, CT USA

[5] Copenhagen Univ Hosp, Dept Cardiol, Rigshosp, Copenhagen, Denmark

[6] St Lukes Mid Amer Heart Inst, Kansas City, MO USA

[7] Univ Missouri, Kansas City, MO 64110 USA

[8] Natl Univ Cordoba, Cordoba, Argentina

[9] Wroclaw Med Univ, Dept Heart Dis, Wroclaw, Poland

[10] Brigham & Womens Hosp, Div Cardiovasc, 75 Francis St, Boston, MA 02115 USA

[11] Univ Wisconsin, Dept Biostat & Med Informat, Madison, WI USA

[12] AstraZeneca R&D, Gothenburg, Sweden

[13] Univ Minnesota, Dept Cardiol, Minneapolis, MN USA

[14] Taipei Vet Gen Hosp, Gen Clin Res Ctr, Taipei, Taiwan

[15] Taipei Vet Gen Hosp, Div Cardiol, Taipei, Taiwan

[16] Natl Yang Ming Univ, Taipei, Taiwan

[17] Max Super Special Hosp, Dept Cardiol, New Delhi, India

[18] Univ Med Ctr Groningen, Dept Cardiol, Groningen, Netherlands

[19] Univ Groningen, Groningen, Netherlands

[20] Inst Cardiovasc Buenos Aires, Div Cardiol, Buenos Aires, DF, Argentina

[21] Comenius Univ, Dept Internal Med, Bratislava, Slovakia

[22] Fudan Univ, Dept Cardiol, Shanghai Inst Cardiovasc Dis, Shanghai, Peoples R China

[23] Fudan Univ, Zhongshan Hosp, Shanghai, Peoples R China

[24] Univ Calgary, Cardiac Sci & Med, Calgary, AB, Canada

[25] Natl Cardiol Hosp, Clin Cardiol, Sofia, Bulgaria

[26] Natl Cerebral & Cardiovasc Ctr, Cardiovasc Div Med, Osaka, Japan

[27] Sahlgrens Acad, Dept Mol & Clin Med & Cardiol, Gothenburg, Sweden

[28] Univ Toronto, Div Cardiac Surg, St Michaels Hosp, Toronto, ON, Canada

来源：

EUROPEAN HEART JOURNAL | 2020年 / 41卷 / 36期

关键词：

Heart failure; Blood pressure; Hypotension; SGLT2; inhibitor; EJECTION FRACTION; MORTALITY; SACUBITRIL/VALSARTAN; MORBIDITY; EFFICACY; SAFETY;

D O I：

10.1093/eurheartj/ehaa496

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Aims Concern about hypotension often leads to withholding of beneficial therapy in patients with heart failure and reduced ejection fraction (HFrEF). We evaluated the efficacy and safety of dapagliflozin, which lowers systolic blood pressure (SBP),according to baseline SBP in Dapagliflozin and Prevention of Adverse Outcomes in Heart Failure trial (DAPA-HF). Methods and results Key inclusion criteria were: New York Heart Association Class II-IV, left ventricular ejection fraction <= 40%, elevated N-terminal pro-B-type natriuretic peptide level, and SBP >= 95 mmHg. The primary outcome was a composite of worsening heart failure or cardiovascular death. The efficacy and safety of dapagliflozin were examined using SBP as both a categorical and continuous variable. A total of 1205 patients had a baseline SBP <110 mmHg; 981 >= 110 < 120; 1149 >= 120 < 130; and 1409 >= 130 mmHg. The placebo-corrected reduction in SBP from baseline to 2 weeks with dapagliflozin was -2.54 (-3.33 to -1.76) mmHg (P <0.001), with a smaller between-treatment difference in patients in the lowest compared to highest SBP category. Patients in the lowest SBP category had a much higher rate (per 100 person-years) of the primary outcome [20.6, 95% confidence interval (95% CI) 17.6-24.2] than those in the highest SBP category (13.8, 11.7-16.4). The benefit and safety of dapagliflozin was consistent across the range of SBP; hazard ratio (95% CI) in each SBP group, lowest to highest 0.76 (0.60-0.97), 0.76 (0.57-1.02), 0.81 (0.61-1.08), and 0.67 (0.51-0.87), P interaction = 0.78. Study drug discontinuation did not differ between dapagliflozin and placebo across the SBP categories examined. Conclusion Dapagliflozin had a small effect on SBP in patients with HFrEF and was superior to placebo in improving outcomes, and well tolerated, across the range of SBP included in DAPA-HF. [GRAPHICS] .

引用

页码：3402 / 3418

页数：17

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