低脉压与晚期慢性心衰患者利钠肽和死亡率升高独立相关

作     者：Voors A. A. Petrie C. J. Petrie M. C. 任付先 

作者机构：Department of Cardiology Thoraxcenter University Hospital Groningen PO Box 30001 9700 RB Groningen Netherlands 

出 版 物：《世界核心医学期刊文摘（心脏病学分册）》 (Digest of the World Core Medical Journals(Cardiology))

年 卷 期：2006年第2卷第1期

页      面：44-44页

学科分类：1002[医学-临床医学] 100201[医学-内科学(含：心血管病、血液病、呼吸系病、消化系病、内分泌与代谢病、肾病、风湿病、传染病)] 10[医学] 

主　　题：慢性心衰患者 死亡率 利钠肽 低脉压 升高 晚期 CHF患者 预测价值 平均年龄 疾病发生率 

摘      要：Aims: An increased pulse pressure(PP) has consistently predicted increased cardiovascular morbidity and mortality in cardiovascular risk patients and mild chronic heart failure(CHF). In contrast, a decreased PP was related to increased mortality in patients with acute decompensated heart failure. However, the predictive value of PP in patients with advanced CHF is not known. Methods and results: PP was analysed for its effect on mortality, adjusting for other modifiers of risk, using Cox proportional hazards regression analysis of data collected from 1901 patients with New York Heart Association Class III or IV CHF(mean age 65 and mean ejection fraction 0.26). Natriuretic peptides were measured in a subgroup. Multivariable Cox-regression analysis demonstrated that lower PP was associated with an increased mortality[hazard ratio(HR) 0.91 per 10 mmHg; 0.93-0.99], independent of mean arterial pressure(MAP) and other well known prognostic markers. In patients with a PP below the median value of 45 mmHg, PP was a stronger predictor of mortality than MAP(HR for PP 0.80 per 10 mmHg; 0.64-0.99). In patients with a PP above the median value of 45 mmHg, MAP was a stronger predictor of mortality than PP(HR for MAP 0.83 per 10 mmHg increase; 0.72-0.95). In addition, lower PP was independently related to increased atrial natriuretic peptide(ANP) and B-type natriuretic peptide(BNP). Conclusion: In patients with advanced CHF, low PP is an independent predictor of mortality. In addition, low PP was related to increased levels of ANP and BNP.