Study on influence of different blood pressure control goals and medication regimens on prognosis of elderly patients with heart failure complicated with hypertension
Objective To analyze the influence of different blood pressure control goals and medication regimens on prognosis of elderly patients with heart failure complicated with hypertension.Methods A total of 150 elderly patients with heart failure combined with hypertension were selected,of which 118 cases were effectively followed up.According to the blood pressure control goals at the time of admission,the 118 patients were included in the intensive antihypertensive group[antihypertensive goal within 1 h of admission:systolic blood pressure<130 mm Hg(1 mm Hg=0.133 kPa);74 cases]and the non-intensive antihypertensive group(antihypertensive goal within 1 h of admission:systolic blood pressure 130-150 mm Hg;44 cases);in addition,they were included in group A(22 cases),group B(27 cases),group C(24 cases),group D(25 cases),and group E(20 cases)according to the difference of antihypertensive medications taken at the time of discharge.Group A received calcium channel blocker(CCB)combined with angiotensin-converting enzyme inhibitor(ACEI),group B received CCB combined with angiotensin Ⅱ receptor blockers(ARB),group C received ACEI combined with diuretic,group D received ARB combined with diuretic,and group E received CCB combined with β-blocker(β-B).The influence of different blood pressure control objectives on the prognosis of patients was analyzed,and the influence of different medication regimens on the prognosis of patients.Results The left ventricular ejection fraction(LVEF),left ventricular end-diastolic diameter(LVEDd),left ventricular end-systolic diameter(LVESd),amino-terminal pro-brain natriuretic peptide(NT-proBNP),systolic blood pressure,day systolic blood pressure standard deviation(dSSD),day diastolic blood pressure standard deviation(dDSD),night systolic blood pressure standard deviation(nSSD)and night diastolic blood pressure standard deviation(nDSD)were compared between the intensive antihypertensive group and the non-intensive antihypertensive group,and there was no significant difference(P>0.05).At 6 months of follow-up,LVEF in both groups was higher than that at the time of enrollment,while LVEDd,LVESd,NT-proBNP,systolic blood pressure,diastolic blood pressure,dSSD,dDSD,nSSD and nDSD were lower than those at the time of enrollment;the intensive antihypertensive group had higher LVEF of(45.41±2.53)%than(42.08±2.96)%in the non-intensive antihypertensive group;the intensive antihypertensive group had LVEDd of(46.51±2.44)mm,LVESd of(32.98±1.89)mm,NT-proBNP of(360.15±33.14)pg/ml,systolic blood pressure of(133.28±16.47)mm Hg,diastolic blood pressure of(82.93±6.95)mm Hg,dSSD of(8.67±1.62)mm Hg,dDSD of(8.14±0.29)mm Hg,nSSD of(7.28±2.03)mm Hg and nDSD of(8.09±1.46)mm Hg,which were lower than(51.44±4.07)mm,(38.03±1.49)mm,(577.14±35.60)pg/ml,(145.23±12.39)mm Hg,(87.71±7.16)mm Hg,(10.62±2.45)mm Hg,(8.27±0.33)mm Hg,(9.51±1.37)mm Hg and(8.79±1.35)mm Hg in the non-intensive antihypertensive group;there was significant difference(P<0.05).The rate of heart failure rehospitalization within 1 year of follow-up was 2.70%in the intensive antihypertensive group,which was lower than 18.18%in the non-intensive antihypertensive group,and there was significant difference(P<0.05).The difference in mortality rate between the two groups was not statistically significant(P>0.05).At 6 months of follow-up,the LVEF of group A,group B,group C,and group D was higher than that of group E;the LVEDd,LVESd,NT-proBNP and systolic blood pressure,diastolic blood pressure,dSSD,dDSD,nSSD,and nDSD were lower than that of group E,and there was significant difference(P<0.05).The rates of heart failure rehospitalization within 1 year of follow-up in group A,group B,group C,and group D were 0,3.70%,4.17%,and 4.00%,which were lower than 35.00%of group E,and the difference was statistically significant(P<0.05).There was no statistically significant difference in mortality rate among the five groups(P>0.05).Conclusion After receiving early intensified antihypertensive treatment,elderly patients with heart failure and hypertension have better cardiac function recovery and blood pressure control effects;in addition to CCB combined with β-B,the combination of CCB,ACEI,ARB and diuretics selected according to the individual situation of patients can also achieve good blood pressure control effect and reduce the risk of rehospitalization of heart failure.
Blood pressure control goalsMedication regimenHeart failure complicated with hypertensionPrognosisOld age
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NSTL
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