Relationship between resting heart rate and incident heart failure in patients with hypertension: The Kailuan Cohort Study in China

An elevated heart rate increases the risk of cardiovascular disease, but the relationship between resting heart rate (RHR) and the risk of heart failure (HF) in hypertensive patients is unclear. This study was performed to assess the relationship between elevated RHR and incident HF in hypertensive patients. In total, 16 286 hypertensive patients from the Kailuan cohort were enrolled and underwent three physical examinations. According to mean RHR based on quartile, the hypertensive patients were divided into four groups: Q1 (mean RHR ≤ 69 bpm), Q2 (69 bpm < mean RHR ≤ 74 bpm), Q3 (74 bpm < mean RHR ≤ 79 bpm), and Q4 (mean RHR > 79 bpm). The cumulative mortality rate was analyzed by using the Kaplan–Meier method, with comparisons among RHR quartiles. Cox proportional hazards regression models and restricted cubic spline models were established to evaluate the association between RHR and risk of incident HF. After adjustment for confounders, the hazard ratio (HR) for HF was 1.97(95% CI: 1.28‐3.04, P < .001) in the fourth quartile compared to the first quartile. Each 1‐standard deviation [10 (beats/min)] increase in RHR was associated with a 40% increase in the risk of incident HF. Restricted cubic spline models presented a linear relationship between RHR and incident HF. Our study suggests that elevated RHR is associated with an enhanced risk of HF in hypertensive patients.     

Weight loss, muscle strength, and angiotensin-converting enzyme inhibitors in older adults with congestive heart failure or hypertension

OBJECTIVES: To determine whether angiotensin-converting enzyme (ACE) inhibitor use may be associated with weight maintenance and sustained muscle strength (measured by grip strength) in older adults. DESIGN: Data from the Cardiovascular Health Study (CHS), a community-based prospective cohort study of 5,888 older adults, were used. SETTING: Subjects were recruited from four U.S. sites beginning in 1989; this analysis included data through 2001. PARTICIPANTS: CHS participants with congestive heart failure (CHF) or treated hypertension. MEASUREMENTS: The exposure, current ACE inhibitor use, was ascertained by medication inventory at annual clinic visits; the outcomes were weight change and grip-strength change during the following year. Multivariate linear regression was used, accounting for correlations between observations on the same participant over time. RESULTS: The average annual weight change was -0.38 kg in 2,834 participants (14,443 person-years) with treated hypertension and -0.62 kg in 342 participants (980 person-years) with CHF. ACE inhibitor use was associated with less annual weight loss after adjustment for potential confounders: a difference of 0.17 kg (95% confidence interval (CI)=0.05-0.29) in those with treated hypertension and 0.29 kg (95% CI=-0.25-0.83) in those with CHF. There was no evidence of association between ACE inhibitor use and grip-strength change. CONCLUSION: ACE inhibitor use may be associated with weight maintenance, but not maintenance of muscle strength, in older adults with treated hypertension.     

Association of preexisting hypertension with the morality in patients with systolic heart failure in Taiwan: The TSOC-HFrEF registry

PurposeTo investigate the association of preexisting hypertension at admission with the mortality in patients with systolic heart failure (HF).MethodWe prospectively investigated the association of preexisting hypertension with the mortality among 1351 patients with HF in Taiwan during an average 12 months (range: 8 months–18 months) follow-up period. A multivariate cox regression analysis for the overall cohort and a subgroup analysis by age were performed.ResultsAfter adjustment for all potential risk factors, the associations of preexisting hypertension with cardiovascular mortality were significantly reduced in the overall cohort and those aged less than 65 years (hazard ratios (HR): 0.53, 95% confidence intervals (CI): 0.33–0.84, and 0.28, 95% CI: 0.11–0.67, respectively). However, the associations with all-cause mortality were not significantly different in these two groups (HR: 0.77, 95% CI: 0.54–1.09, and 0.59, 95% CI: 0.32–1.07, respectively). Furthermore, the associations were all nonsignificant in the patients aged older than 65 years.ConclusionPreexisting hypertension have an inverse association with cardiovascular mortality in the Asian patients with systolic HF, particularly for those with younger ages.     

Prospective study of obstructive sleep apnea and incident coronary heart disease and heart failure

Background-Clinic-based observational studies in men have reported that obstructive sleep apnea is associated with an increased incidence of coronary heart disease.The objective of this study was to assess the relation of obstructive sleep apnea to incident coronary heart disease and heart failure in a general community sample of adult men and women.Methods and Results-A total of 1927 men and 2495 women ≥40 years of age and free of coronary heart disease and heart failure at the time of baseline polysomnography were followed up for a median of 8.7 years in this prospective longitudinal epidemiological study.After adjustment for multiple risk factors,obstructive sleep apnea was a significant predictor of incident coronary heart disease(myocardial infarction,revascularization procedure,or coronary heart disease death)only in men ≤70 years of age(adjusted hazard ratio 1.10 [95% confidence interval 1.00 to 1.21] per 10-unit increase in apnea-hypopnea index [AHI])but not in older men or in women of any age.Among men 40 to 70 years old,those with AHI ≥30 were 68% more likely to develop coronary heart disease than those with AHI <5.Obstructive sleep apnea predicted incident heart failure in men but not in women(adjusted hazard ratio 1.13 [95% confidence interval 1.02 to 1.26] per 10-unit increase in AHI).Men with AHI ≥30 were 58% more likely to develop heart failure than those with AHI <5.Conclusions-Obstructive sleep apnea is associated with an increased risk of incident heart failure in community-dwelling middle-aged and older men;its association with incident coronary heart disease in this sample is equivocal.     

Long-term effect of isosorbide dinitrate and nifedipine, singly and in association, in patients with chronic heart failure

The effect of 2-month treatment with isosorbide dinitrate (120 mg day-1), nifedipine (2 x 20 mg day-1) and their combination has been assessed in 16 patients with mild to moderate chronic cardiac failure. Isosorbide dinitrate decreased right atrial (-23%), pulmonary wedge (-20%) and pulmonary arterial (-17%) pressures but did not significantly change either cardiac output or systemic and pulmonary vascular resistance. Nifedipine increased cardiac output (+13%) and decreased systemic and pulmonary vascular resistance (both -17%) with no change of pressures. Combined therapy with both drugs decreased ventricular filling pressures (-8% and -15%), systemic (-20%) and pulmonary (-13%) arterial pressures, increased cardiac output (+26%) and decreased both systemic (-29%) and pulmonary (-29%) vascular resistances. Changes during exercise were almost the same as at rest. The effect of both drugs was more pronounced in patients with more severely pathological haemodynamic measurements before treatment. We conclude that combined treatment with both preload- and afterload-reducing agents can preserve or even potentiate a favourable haemodynamic effect of individual drugs.     

Targets and management of hypertension in heart failure: focusing on the stages of heart failure

Hypertension is highly prevalent worldwide and is the major risk factor for heart failure (HF). More than half of the patients with HF in Asia suffer from hypertension. According to the 2022 American Heart Association/American College of Cardiology/Heart Failure Society of America HF guideline, there are four stages of HF, including at risk for HF (stage A), pre‐HF (stage B), symptomatic HF (stage C), and advanced HF (stage D). Given the high prevalence of hypertension as well as HF and the stronger association between hypertension and cardiovascular diseases in Asians compared to the west, measures to prevent and alleviate the progression to clinical HF, especially controlling the blood pressure (BP), are of priority for Asian populations. After reviewing evidence‐based studies, we propose a BP target of less than 130/80 mmHg for patients at stages A, B, and C. However, relatively higher BP may represent an opportunity to maximize guideline‐directed medical therapy (GDMT), which could potentially result in a better prognosis for patients at stage D. Traditional antihypertensive drugs are the cornerstones for the management of hypertension at stages A and B. Notably, calcium channel blockers (CCBs) are inferior to other drug classes for the preventing of HF, whereas diuretics are superior to others. For patients at stage C, GDMT is essential which also helps the control of BP. In particular, sodium‐glucose cotransporter‐2 (SGLT2) inhibitors are newer therapies recommended for the treatment of HF and presumably even in hypertension to prevent HF. Regarding patients at stage D, GDMT is also recommended if tolerable and measures should be taken to improve hemodynamics.     

The influence of Albunex on the pulmonary circulation in patients with pulmonary hypertension or left heart failure

To determine the safety of the ultrasound contrast agent Albunex,its influence on right and left heart haemodynamics in patientswith pulmonary artery hypertension or left heart failure wasassessed after intravenous injection. Patients with a left ventricular ejection fraction smaller than40% or a systolic pulmonary artery pressure greater than 40%mmHg received 0·08 and 0·22 ml . kg^–1 Albunexand 10 ml albumin in random order during right heart catheterizationand transthoracic echocardiography. Right atrial, systolic anddiastolic pulmonary artery and capillary wedge pressures weremeasured at 3 min and 5 min and cardiac output at 5 min afterthe intravenous injection of Albunex and control. The mean differencesof pre- and postinjection values and their confidence intervalswere tabulated and significance was anticipated if the confidenceinterval did not include 0. Significant changes to pre-injection values could be observedin diastolic pulmonary artery pressure 5 min after the injectionof albumin and 0·08 ml. kg^–1 Albunex, and in rightatrial pressure 5 min after the injection of 0·22 ml.kg^–1 Albunex only. Since intermediate opacification ofthe left ventricle was seen in only four patients with 0·22ml. kg^–1 Albunex, in the patients studied higher dosesof Albunex and their safety need to be assessed.     

高血压患者心力衰竭严重程度与高密度脂蛋白胆固醇水平的关系

目的探讨高血压患者心力衰竭严重程度与血清HDL-C水平的关系。方法采用随机数字表随机抽取法选择高血压患者156例,分为心力衰竭组83例和心功能正常组73例。用酶法检测血清TC、TG;用磷钨酸镁沉淀法检测血清HDL-C;根据Friedewald公式计算血清LDL-C。采用超声心动图诊断并评价心力衰竭的严重程度。结果与心功能正常组比较,心力衰竭组患者血清HDL-C水平明显降低(P<0.05);心力衰竭组患者室间隔、左心室后壁、左心室舒张末内径、左心房内径、心力衰竭超声指数和心室壁节段性运动异常比率明显升高(P<0.05),LVEF明显降低(P<0.05)。Pearson直线相关分析和偏相关分析显示,高血压患者血清HDL-C与心力衰竭超声指数呈负相关(r=-0.230,P<0.05;Υ=-0.262,P<0.05)。结论高血压患者心脏收缩和(或)舒张功能衰竭的严重程度与血清HDL-C水平密切相关。     

Clinical profile, contemporary management and one-year mortality in patients with severe acute heart failure syndromes: The EFICA study

BACKGROUND: Little is known about the epidemiology of acute decompensated heart failure (ADHF) in patients admitted to intensive and coronary care units (ICU/CCU). Observational data may improve disease management and guide the design of clinical trials. AIMS: EFICA is an observational study of the clinical profile, management and survival of ADHF patients admitted to ICU/CCU. METHODS: The study included 599 patients admitted to 60 ICU/CCUs across France. Relevant data was recorded during hospitalisation. Survival was assessed at 4 weeks and 1 year. RESULTS: The main cause of ADHF was ischaemic heart disease (61%); 29% of patients had cardiogenic shock. Mortality was 27.4% at 4 weeks and 46.5% at 1 year, increasing to 43.2% and 62.5%, respectively, when including pre-admission deaths. Shock patients had the highest [57.8% vs. 15.2% without shock (p < 0.001)] and patients with hypertension and pulmonary oedema had the lowest 4-week mortality: (7%). Pre-admission NYHA class III-IV heart failure, not initial clinical presentation, influenced 1-year mortality. CONCLUSION: ADHF is a heterogeneous syndrome. Based on initial clinical presentation, three entities with distinct features and outcome may be described: cardiogenic shock, pulmonary oedema with hypertension, and 'decompensated' chronic heart failure. This should be taken into account in future observational studies, guidelines and clinical trials.     

Readmission and mortality among heart failure patients with history of hypertension in a statewide database

Objective was to examine the temporal trends in readmission and mortality of heart failure (HF) patients with history of hypertension. This study includes 51 141 patients with history of hypertension who were discharged with a first diagnosis of HF between January 1, 2000, and December 31, 2014. Data were obtained from the Myocardial Infarction Data Acquisition System (MIDAS), a statewide database of all hospitalizations for cardiovascular (CV) disease in New Jersey. The temporal trends of mortality, rates of HF‐specific readmission, and all‐cause readmissions up to 1 year after discharge were examined using multivariable logistic regression. The difference in all‐cause mortality at 3 years between patients who were readmitted compared to those who were not readmitted at 1 year was examined. The number of patients with history of hypertension and HF remained unchanged during the study period. Male gender, black race, comorbidities, and admission to non‐teaching hospitals were predictors of HF readmission and CV mortality (P < .05 for all). Readmission rate for any cause increased during the study period (P < .001) while rates of HF readmissions and mortality remained relatively unchanged. Patients that had been readmitted within a year exhibited a significantly higher 3‐year mortality (P < .001). CV mortality among HF patients with history of hypertension did not change significantly between 2000 and 2014, while the rates of all‐cause readmission increased. Patients who were readmitted had higher 3‐year mortality (P < .001) than those who were not.