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收缩压是左室收缩时的最高动脉血压——一般来说，是指血压记录时的第一个读数（当血压记录为120/80 mm Hg时，120 mm Hg即收缩压。）收缩压是患者入院时容易得到的一个重要体征，最新研究发现心衰患者住院时的收缩压水平可以反映心衰的阶段、预后和疾病的进展情况。该研究结果发表在11月8日的《美国医学协会杂志》上。

该研究首次利用大型心衰患者注册资料库——OPTIMIZE-HF 的相关数据，研究人员通过对2003年3月～2004年12月美国259所医院的48,612名心力衰竭患者的资料进行汇总分析发现，心衰患者入院时收缩压较高者住院率较低，出院后的死亡率也较低，这与患者的左室射血分数（衡量心室功能的一项参数）无关。

通常认为，心衰患者由于心功能恶化，往往出现收缩压降低，但该研究显示超过50%的心衰住院患者收缩压>140 mmHg。心衰患者的收缩压不同，住院期间的死亡率也不同：收缩压<120 mm Hg 的死亡率为7.2%，收缩压在120-139 mmHg之间的死亡率为3.6%，收缩压在140-161 mmHg之间的死亡率为2.5%，而收缩压>161 mmHg的死亡率为1.7%。

该研究的第一作者、西北大学芬伯格医学院心脏科的医学教授Mihai Gheorghiade 博士说：“收缩压升高与收缩期压降低患者的病理生理过程不同，心衰患者随着收缩压水平的不同而呈现出不同的临床特点和预后。除外药物治疗作用，患者入院时的收缩压越低，则死亡率越高。医生应根据收缩压水平调整相应的治疗方案。”

Ahmanson-UCLA （加利福尼亚大学洛杉矶分校）心肌病研究中心心血管医学科学部主席Gregg C. Fonarow博士是该研究的主要研究者及领导者，他指出：“在这个有代表性的心衰患者的大样本研究中，患者入院时的收缩压是有效预测心衰死亡率的独立因素。我们希望此研究结果可以使临床医生根据患者的收缩压水平，更有效地评估患者的死亡风险，采取更有针对性的治疗措施。”

 http://www.medicalnewstoday.com/medicalnews.php?newsid=56469

Systolic Blood Pressure Predicts Mortality In Heart Failure Patients

Systolic blood pressure, a readily available vital sign taken at hospital admission, has been found to be a key factor in predicting mortality risk and revealing important disease characteristics for heart failure patients, according to a team of academic researchers.

These new findings indicate that heart failure patients with higher systolic blood pressures had substantially lower death rates compared to patients with lower systolic pressures, and that lower systolic pressures may indicate more advanced disease and a poorer prognosis.

Published in the Nov. 8 issue of the Journal of the American Medical Association, the new study found that the level of systolic blood pressure taken at hospital admission offers insight into different stages of heart failure, prognosis, and disease development. This study also revealed that systolic hypertension is very common in patients admitted to the hospital for heart failure -- present in over 50 percent of patients.

"Systolic blood pressure taken at hospital admission was a strong independent predictor of mortality and morbidity in this large, representative heart failure patient population. We hope the findings may help clinicians more effectively stratify risk and offer more targeted treatments based on a patient's systolic blood pressure level," said Dr. Gregg C. Fonarow, The Eliot Corday Chair in Cardiovascular Medicine and Science, principal investigator and director, Ahmanson-UCLA Cardiomyopathy Center.

Systolic blood pressure demonstrates the maximum arterial pressure during contraction of the left ventricle of the heart -- typically the first number in a blood pressure reading (for example, 120 mm Hg when the blood pressure is reported as 120/80 mm Hg -- measured in millimeters of mercury). Heart failure occurs when the heart is not working effectively, including when the heart's left ventricle can't pump enough blood to the body's other organs.

The study is the first to utilize patient data from a large heart failure patient registry called the Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure (OPTIMIZE-HF). Researchers included information on 48,612 heart failure patients seen at 259 U.S. hospitals between March 2003 and December 2004.

Researchers found that patients with higher systolic blood pressures at hospital admission had substantially lower in-hospital and post-discharge mortality rates compared to patients with lower systolic pressures. This finding applied to patients irrespective of their left ventricular ejection fraction, a common measure of ventricular function.

"Elevated systolic blood pressure appears to signal specific pathophysiological processes that differ from the underlying processes in patients with low systolic blood pressure. Because the characteristics and outcomes are different among patients with heart failure with varying systolic blood pressure levels, management may need to vary according to this readily available vital sign." said Dr. Mihai Gheorghiade, professor of medicine, division of cardiology, Feinberg School of Medicine, Northwestern University and first author of the study.

The study revealed the following in-hospital mortality rates by systolic blood pressure levels: 7.2 percent mortality rate for patients with low systolic pressures of less than 120 mm Hg.; 3.6 percent mortality rate for patients with pressures between 120 and 139 mm Hg (generally considered in the normal range); 2.5 percent for patients with higher systolic pressures between 140-161 mm Hg; and 1.7 percent mortality rate for patients with very high systolic pressures over 161 mm Hg.

"We found that despite current pharmacologic therapies, the lower the admission systolic blood pressure level, the higher the patient mortality rate," said Gheorghiade.

According to researchers, it had traditionally been thought that most patients with heart failure had lower systolic blood pressures when they presented to the hospital with worsened heart failure, but the study revealed that over fifty percent of patients had a high systolic blood pressure -- over 140 mm Hg.

"To optimize treatment, we may need to medically approach heart failure patients differently depending if their systolic blood pressures are normal, low or high," said Fonarow.

Researchers note that systolic blood pressure may be an indicator of the stage of heart failure with lower systolic blood pressures indicating more advanced disease and prognosis. Clinical trials designed for each patient group may lead to more insight into heart failure disease development.

The study was funded by GlaxoSmithKline that sponsors the OPTIMIZE-HF registry. Drs. Gheorghiade and Fonarow have received research grants, honoraria and served as consultants for GlaxoSmithKline. Additional author financial disclosure is available in the full JAMA paper on page 2226.

Other study authors include Dr. William T. Abraham, Division of Cardiology, Ohio State University; Nancy M. Albert, RN, Ph.D., and Dr. James B. Young, Gorge M. and Linda H. Kaufman Center for Heart Failure, Cleveland Clinic Foundation; Dr. Barry H. Greenberg, Department of Medicine, University of California San Diego Medical Center; Dr. Christopher M. O'Connor and Lilin She, Ph.D., Duke Clinical Research Institute; Wendy Gattis Stough, Pharm.D., Department of Medicine, Duke University Medical Center and Campbell University School of Pharmacy, Research Triangle Park; Dr. Clyde W. Yancy, Department of Medicine, University of Texas Southwestern Medical Center. Dr. Yancy is now with the Baylor Heart and Vascular Institute, Baylor University Medical Center.

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