JAMA：常用高血压药物能造福更多心衰患者

2012年11月28日 --瑞典卡罗琳斯卡医学院一项新研究表明常用来治疗心脏衰竭和高血压的药物可能具有更广泛的应用范围，或许可以用来治疗所谓的HFPEF-A型心脏衰竭。到现在为止HFPEF-A型心脏衰竭是无法治疗的。

相关研究成果发表在科学杂志JAMA上，结果表明一组HFPEF患者使用这些药物后死亡率下降。心脏衰竭影响总人口的3％，并以两种形式存在：收缩能力下降和心脏舒张能力下降。前者影响较年轻的患者，大多是男人，这种类型疾病是可以治疗的。

后者即所谓的HFPEF型心脏衰竭，主要影响老年患者和妇女，到现在为止还没有任何疾病的治疗方法。在本研究中研究人员分析了约40,000名病人。

结果表明HFPEF患者服用ACE抑制剂或血管紧张素受体阻断剂后，有较好的存活率。在对大量其他因素如病人的年龄，一般健康状况和其他因素进行调整后，最终的死亡率降低了10％。

心脏衰竭患者中，应激激素分泌长期损害心，ACE抑制剂和血管紧张素受体阻滞剂能停止这些激素造成的不利影响。

在以前的随机研究，药物并没有被证明对HFPEF有效，研究人员认为主要原因是早期的研究样本数太小。同时他们指出，因为他们的研究不是随机的，还需要进一步研究以确认这些药物的治疗功效

与心衰相关的拓展阅读：

• JACC：老年人进行体力活动可降低心衰风险
• 长链单不饱和脂肪酸可增加心衰发生
• Circulation：长链单不饱和脂肪酸可增加心衰发生风险
• Int J Cardiol ：贫血可预测心衰患者健康相关生活质量 更多信息请点击：有关心衰更多资讯

Association between use of renin-angiotensin system antagonists and mortality in patients with heart failure and preserved ejection fraction.
CONTEXT
Heart failure with preserved ejection fraction (HFPEF) may be as common and as lethal as heart failure with reduced ejection fraction (HFREF). Three randomized trials of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (ie, renin-angiotensin system [RAS] antagonists) did not reach primary end points but may have had selection bias or been underpowered.
OBJECTIVE
To test the hypothesis that use of RAS antagonists is associated with reduced all-cause mortality in an unselected population with HFPEF.
DESIGN, SETTING, AND PATIENTS
Prospective study using the Swedish Heart Failure Registry of 41,791 unique patients registered from 64 hospitals and 84 outpatient clinics between 2000 and 2011. Of these, 16,216 patients with HFPEF (ejection fraction ≥40%; mean [SD] age, 75 [11] years; 46% women) were either treated (n = 12,543) or not treated (n = 3673) with RAS antagonists. Propensity scores for RAS antagonist use were derived from 43 variables. The association between use of RAS antagonists and all-cause mortality was assessed in a cohort matched 1:1 based on age and propensity score and in the overall cohort with adjustment for propensity score as a continuous covariate. To assess consistency, separate age and propensity score-matched analyses were performed according to RAS antagonist dose in patients with HFPEF and in 20,111 patients with HFREF (ejection fraction <40%) in the same registry.
MAIN OUTCOME MEASURE
All-cause mortality.
RESULTS
In the matched HFPEF cohort, 1-year survival was 77% (95% CI, 75%-78%) for treated patients vs 72% (95% CI, 70%-73%) for untreated patients, with a hazard ratio (HR) of 0.91 (95% CI, 0.85-0.98; P = .008). In the overall HFPEF cohort, crude 1-year survival was 86% (95% CI, 86%-87%) for treated patients vs 69% (95% CI, 68%-71%) for untreated patients, with a propensity score-adjusted HR of 0.90 (95% CI, 0.85-0.96; P = .001). In the HFPEF dose analysis, the HR was 0.85 (95% CI, 0.78-0.83) for 50% or greater of target dose vs no treatment (P < .001) and 0.94 (95% CI, 0.87-1.02) for less than 50% of target dose vs no treatment (P = .14). In the age and propensity score-matched HFREF analysis, the HR was 0.80 (95% CI, 0.74-0.86; P < .001).
CONCLUSION
Among patients with heart failure and preserved ejection fraction, the use of RAS antagonists was associated with lower all-cause mortality.