ARNI联合他汀对老年高血压并HFpEF患者疗效的观察

Efficacy of ARNI Combined with Statins in Elderly Patients with Hypertension and HFpEF

摘要: 目的：探讨ARNI联合他汀对老年高血压并HFpEF患者的临床疗效。方法：选择2020年1月~2021年10月青大附院住院的年龄 ≥ 65岁高血压合并射血分数保留的心力衰竭患者，根据用药方案分为ARNI + 他汀组40例，他汀组40例，对照组40例，分析治疗前、治疗6个月后的临床疗效，实验室指标：C反应蛋白(CRP)、低密度脂蛋白(LDL)、N端前体脑利钠肽(NT-proBNP)，心脏超声指标：左心房容积指数(LAVI)、左心室质量指数(LVMI)、左心室舒张早期二尖瓣血流最大速度/舒张早期二尖瓣环峰值速度(E/e’)、左心室射血分数(LVEF)、不良反应、再住院及死亡事件，评估ARNI联合他汀对老年高血压并HFpEF患者生活质量、心功能及预后的影响。结果：治疗后，ARNI + 他汀组：总有效率提高，脉压、LDL、CRP、NT-proBNP、LAVI、LVMI、E/e’水平明显降低(p < 0.05)，他汀组：脉压、LDL、CRP、NT-proBNP、LVMI、E/e’下降(p < 0.05)，对照组：脉压下降(p < 0.05)，其他指标差异无统计学意义(p > 0.05)；组间比较：ARNI + 他汀组比另外两组，脉压、LDL、CRP、NT-proBNP、LAVI、LVMI、E/e’水平明显降低(p < 0.05)；各组随访6个月因心衰再入院患者分别为2例(5%)，5例(12.5%)，10例(25%)，对照组死亡1例。各组无明显药物不良反应，差异无统计学意义(p > 0.05)。结论：ARNI联合他汀可以明显改善老年高血压并HFpEF患者生活质量、逆转心肌重塑、改善心脏功能及预后，可以指导临床用药。

Abstract: Objective: To investigate the clinical efficacy of ARNI combined with statins in elderly patients with hypertension complicated with HFpEF. Methods: From January 2020 to October 2021, hypertensive heart failure patients aged ≥ 65 years with retained ejection fraction were selected and divided into ARNI + statin group (n = 40), statin group (n = 40) and control group (n = 40) according to medica-tion regimen. The clinical efficacy before and after 6 months of treatment were analyzed, laboratory indicators: C-reactive protein (CRP), low-density lipoprotein (LDL), N-terminal precursor brain na-triuretic peptide (NT-proBNP), cardiac ultrasound indicators: Left atrial volume index (LAVI), left ventricular mass index (LVMI), left ventricular early diastolic maximum mitral flow velocity/early diastolic mitral annular peak velocity (E/e’), left ventricular ejection fraction (LVEF), adverse drug reactions, rehospitalization and death endpoints, and evaluate the effect of ARNI combined with statin on the quality of life, cardiac function and prognosis of elderly patients with hypertension and HFpEF. Results: After treatment: the ARNI + statin group increased the total effective rate, and sig-nificantly decreased the levels of pulse pressure, LDL, CRP, NT-proBNP, LAVI, LVMI, and E/e’ (p < 0.05). Pulse pressure, LDL, CRP, NT-proBNP, LVMI, E/e’ decreased in the statin group (p < 0.05). The pulse pressure in the control group decreased (p < 0.05), and there was no significant difference in other indicators (p > 0.05); Comparison between groups: compared with the other two groups, the ARNI + statin group had significantly lower pulse pressure, LDL, CRP, NT-proBNP, LAVI, LVMI, and E/e’ levels (p < 0.05); During the 6-month follow-up in each group, 2 patients (5%), 5 patients (12.5%), and 10 patients (25%) were readmitted due to heart failure, respectively, and 1 patient died in the control group. Conclusion: ARNI combined with statins can significantly improve the quality of life, reverse ventricular remodeling, improve cardiac function and long-term prognosis in elderly patients with hypertension and HFpEF, which can guide clinical medication.