The Relationship Between The Level Of Blood Pressure On Admission And Recent Prognosis Of Patients With Chronic Heart Failure

Objective:Chronic heart failure(CHF)is the end stage of the devel opment of various organic heart disease and the most important cause o f death.Its high incidence,complex condition,poor prognosis.In recent year s,China’s annual new patients with chronic heart failure was on the rise,a serious threat to the quality of life and survival of patients,early risk stratification,as soon as possible to give effective and reasonable treatme nt can improve the prognosis of heart failure.Heart failure is associated with changes in neurohumoral factors,blood pressure as a comprehensive indicator of systemic hemodynamics,measurement is simple,noninvasive,repeatable operation and also by the regulation of neurohumoral,suggest ing that blood pressure in the development of heart failure in the proce ss of a certain significance.In this study,119 patients with chronic heart failure were admitted to hospital blood pressure measurement and follow-up,to investigate the value of blood pressure in patients with chronic heart failure after admission.Metheds:Continuous selection from January 2015 to December 2015 at the Second Hospital of Hebei Medical University cardiovascular three subjec ts of chronic heart failure patients were 119 people.Selection criteria:clin ical diagnosis of heart failure,a clear basic heart disease history,history a re more than six months,older than 18 years old.which is based on the NYHA cardiac function grade Ⅱ~Ⅳ grade,and N-terminal natriuretic pep tide precursor>2000ng/L.Exclusion criteria:there are cognitive impairment,confusion;hypertrophic obstructive cardiomyopathy,valvular heart disease,p ericardial constriction,pericardial effusion,myocarditis,congenital heart disease;Acute myocardial infarction,acute heart failure;combined with maligna nt arrhythmia;Secondary hypertension,anemia,stroke,massive pleural effusi on,pneumonia,chronic obstructive pulmonary disease,etc;Accompanied by severe liver and kidney dysfunction;accompanied by other prognosis of other serious diseases(such as malignant tumors,etc.).All patients were admitted to the hospital were strictly followed the Chinese blood pressure measurement guidelines to measure and record blood pressure,record the patient age,gender,weight,height,according to the New York Heart Association Cardiac function classification of patients with cardiac function classification;The left ventricular ejection fraction(LVEF)and left ventricular end diastolic diameter(LVEDD)were measured by cardiac ultrasonography.NT-proBNP,total bilirubin,albumin,blood lipids,creatinine and other biochemical indexes were measured within 24 hours.After admission in accordance with the Chinese heart failure prevention and treatment guidelines to give the appropriate treatment.After regular hospital follow-up,to the hospital for the initial follow-up time,Heart-borne death was the end point of follow-up,The follow-up date is at least 2016-6 and the follow-up period is at least June.According to the blood pressure of patients admitted to different blood pressure levels,Kaplan-Meier method used to draw the survival curve and its log-rank statistical test.Cox risk factor was used to analyze the prognosis of patients with chronic heart failure(CHF),and to evaluate the prognosis of patients with chronic heart failure(CHF)by using the Cox risk ratio and multivariate analysis.The experimental data will be dealed with by using SPSS 21.0 software for statistical analysis.Metrological data were expressed as mean ± standard deviation((?)±s)or median(the first quartile,the third quartile)[M(Q1,Q3)],and count data were expressed as the number of cases(percentage).The t test or non-parametric test was used to compare the Metrological data.Comparison between the count data using χ2 test or Fish exact probability method.Correlation analysis using Pearson correlation coefficient or Spearman correlation coefficient.The Kaplan-Meier survival curves were used between the three groups.Comparison between groups using log-rank test.The Cox proportional hazards model was used to analyze the univariate and multivariate survival analysis.All statistics were bilateral test,with P <0.05 for the difference was statistically significant.Result:A total of 119 patients with chronic heart failure were enrolled,including 77 males and 42 females,aged 44 to 90(67.3 ± 10.0)years,and BMI 23.8 ± 2.6 kg/m2.Etiology:ischemic cardiomyopathy(coronary heart)in 79 cases,dilated cardiomyopathy(heart)in 26 cases,hypertensive heart disease(high heart)in 14 cases.According to the New York Heart Association(NYHA)classification: Class II 51 cases,grade III 47 cases,IV grade 21 cases.1 Comparison of clinical data between cardiogenic death group and non-death groupA total of 119 patients were enrolled in the study,with 22 patients with cardiac origin.At the end of follow-up,the patients were divided into death group and non-death group.There was no significant difference in heart rate between the two g roups at age,sex ratio,body mass index(BMI),cause composition,serum albumin,serum creatinine,serum potassium,total cholesterol,low density lipoprotein cholesterol and admission(P>0.05).There were significantly more patients with grade IV in the death group than in the non-death group(68.2% vs 6.2%),Patients with cardiac function grade II were significantly less than those in the non-death group(4.5% vs 51.5%),the difference was statistically significant(P <0.01).The NT-proBNP[9750(7805,10980)vs 3210(2022,5068)],lnNT-pro B NP(9.15±9.16 vs 8.03±8.03)and TBIL(21.8±10.5 vs 12.2±5.0)were signif icantly higher in the death group than those in the non-death group,the difference was statistically significant(P <0.01).Death group,LVEF(27.4±5.0 vs 42.1±9.1),admission SBP(108.4±10.5 vs 122.5±8.9),admission DBP(65.5±5.4 vs 72.4±7.7),admission PP(42.9±12.3 vs 50.2±9.3)was significantly lower than non-death group,the difference was statistically significan t(P <0.01).2 The correlation between the admission blood pressure and the ab ove two groups of clinical data were analyzedBy Pearson correlation or Spearman correlation analysis showed:The admission systolic blood pressure was negatively correlated wit h NT-proBNP(rs=-0.266,P<0.01),positively correlated with LVEF(rs=0.352,P<0.01),negatively correlated with LVEDD(rs=-0.225,P<0.05),negatively correlated with NYHA grade(rs=-0.201,P<0.05),and negatively correlated with TBIL(rs=-0.232,P<0.05).The admission diastolic blood pressure was negatively correlated wi th NT-proBNP(rs=-0.227,P<0.05),positively correlated with LVEF(r=0.188,P<0.05),negatively correlated with LVEDD(r=-0.202,P<0.05),negatively co rrelated with NYHA grade(rs=-0.219,P<0.05),and negatively correlated with TBIL(r=-0.202,P<0.05).3 Kaplan-Meier method was used to plot the survival curve of different blood pressure levels and log-rank statistical testAccording to the admission SBP,the admission SBP is divided into <100mmHg,100~130mmHg,>130mmHg three groups.There was a difference in survival between the three groups by log-rank test(χ2=33.935,P<0.01).Its pairwise comparison,the survival rate of admission SBP<100mmHg in patients with chronic heart failure was significantly lower than that in patients with chronic heart failure with admission SBP at 100~130mmHg and admission SBP>130mmHg(χ2=27.659,17.922,P<0.01).The survival rate of admission SBP patients with chronic heart failure between 100 and 130 mmHg was not significantly different from admission SBP>130mmHg in patients with chronic heart failure(χ2=1.561,P>0.05).According to the admission DBP,will be admitted to DBP is divided into <60mmHg,60~80mmHg,>80mmHg three groups.The survival curve was plotted by Kaplan-Meier method,and there was no difference in survival between the three groups by log-rank test(χ2=3.324,P=0.190).According to the admission of PP,will be divided into hospital <35mmHg,35~55mmHg,>55mmHg three groups.There was a difference in su rvival between the three groups by log-rank test(χ2=26.834,P<0.01).Its pairwise comparison,the survival rate of chronic heart failure patients wit h admission PP<35mmHg was significantly lower than that of patients with chronic heart failure who had a PP of 35~55mmHg at admission a nd>55mmHg at admission(χ2=22.279,16.022,P<0.01);While the survival ra te of PP in 35~55mmHg patients with chronic heart failure was no diff erent from that of patients with chronic heart failure with PP>55mmHg(χ2=0.367,P>0.05).4 Univariate Cox proportional hazards regression analysis of cardiac death in patients with chronic heart failureThe risk factors that may have an impact on the prognosis of heart failure were introduced into the Cox regression model,The results show ed that NYHA classification(RR=8.938,95%CI 4.135~19.324),lnNT-pro B NP lnNT-proBNP(RR=38.591,95%CI 11.129~133.822),TBIL(RR=1.159,95%CI 1.105~1.215),LVEF(RR=0.825,95%CI 0.776~0.878),LVEDD(RR=1.107,95%CI 1.059~1.156),admission SBP(RR=0.866,95%CI 0.836~0.942),admission PP(RR=0.935,95%CI 0.898~0.973)had a significant phase e ffect on the prognosis of chronic heart failure(P<0.01).The age,sex,etiol ogy ratio,Alb,SCr,TG,LDL-c,admission heart rate were introduced into the Cox regression model,the Wald test showed no statistically significa nt(P>0.05).5 Multivariate Cox proportional hazards regression analysis of cardiac death in patients with chronic heart failureMultivariate Cox proportional hazards model analysis(Enter method)was used to analyze the prognostic factors of single factor Cox proportional hazards in patients with chronic heart failure.The results showed that only lnNT-proBNP(RR=12.921,95%CI 2.373 ~ 70.353,P < 0.01),admission SBP(RR=0.891,95% CI 0.828~0.958,P<0.01)is an independent predictor of the prognosis of patients with chronic heart failure.Conclusions:1 The survival rate of patients with chronic heart failure at admission SBP<100mmHg and admission PP<35mmHg was significantly reduced.2 Patients with chronic heart failure at admission with poor prognosis of low systolic blood pressure,is to determine the prognosis of patients with chronic heart failure independent predictors.