Dapagliflozin and Apparent Treatment-Resistant Hypertension in Heart Failure With Mildly Reduced or Preserved Ejection Fraction: The DELIVER Trial

医学 射血分数 达帕格列嗪 心力衰竭 内科学 血压 射血分数保留的心力衰竭 心脏病学 人口 安慰剂 糖尿病 2型糖尿病 内分泌学 环境卫生 病理 替代医学
作者
John W. Ostrominski,Muthiah Vaduganathan,Senthil Selvaraj,Brian Claggett,Zi Michael Miao,Akshay S Desai,Pardeep S. Jhund,Mikhail Kosiborod,Carolyn S.P. Lam,Silvio E. Inzucchi,Felipe Martínez,Rudolf A. de Boer,Adrian F. Hernandez,Sanjiv J. Shah,Magnus Petersson,Anna Maria Langkilde,John J.V. McMurray,Scott D. Solomon
出处
期刊:Circulation [Lippincott Williams & Wilkins]
卷期号:148 (24): 1945-1957 被引量:2
标识
DOI:10.1161/circulationaha.123.065254
摘要

Apparent treatment-resistant hypertension (aTRH) is prevalent and associated with adverse outcomes in heart failure with mildly reduced or preserved ejection fraction. Less is known about the potential role of sodium-glucose co-transporter 2 inhibition in this high-risk population. In this post hoc analysis of the DELIVER trial (Dapagliflozin Evaluation to Improve the Lives of Patients with Preserved Ejection Fraction Heart Failure), we evaluated clinical profiles and treatment effects of dapagliflozin among participants with aTRH.DELIVER participants were categorized on the basis of baseline blood pressure (BP), with aTRH defined as BP ≥140/90 mm Hg (≥130/80 mm Hg if diabetes) despite treatment with 3 antihypertensive drugs including a diuretic. Nonresistant hypertension was defined as BP above threshold but not meeting aTRH criteria. Controlled BP was defined as BP under threshold. Incidence of the primary outcome (cardiovascular death or worsening heart failure event), key secondary outcomes, and safety events was assessed by baseline BP category.Among 6263 DELIVER participants, 3766 (60.1%) had controlled BP, 1779 (28.4%) had nonresistant hypertension, and 718 (11.5%) had aTRH at baseline. Participants with aTRH had more cardiometabolic comorbidities and tended to have higher left ventricular ejection fraction and worse kidney function. Rates of the primary outcome were 8.7 per 100 patient-years in those with controlled BP, 8.5 per 100 patient-years in the nonresistant hypertension group, and 9.5 per 100 patient-years in the aTRH group. Relative treatment benefits of dapagliflozin versus placebo on the primary outcome were consistent across BP categories (Pinteraction=0.114). Participants with aTRH exhibited the greatest absolute reduction in the rate of primary events with dapagliflozin (4.1 per 100 patient-years) compared with nonresistant hypertension (2.7 per 100 patient-years) and controlled BP (0.8 per 100 patient-years). Irrespective of assigned treatment, participants with aTRH experienced a higher rate of reported vascular events, including myocardial infarction and stroke, over study follow-up. Dapagliflozin modestly reduced systolic BP (by ≈1 to 3 mm Hg) without increasing risk of hypotension, hypovolemia, or other serious adverse events, irrespective of BP category, but did not improve the proportion of participants with aTRH attaining goal BP over time.aTRH was identified in >1 in 10 patients with heart failure and left ventricular ejection fraction >40% in DELIVER. Dapagliflozin consistently improved clinical outcomes and was well-tolerated, including among those with aTRH.URL: https://www.clinicaltrials.gov; Unique identifier: NCT03619213.
最长约 10秒,即可获得该文献文件

科研通智能强力驱动
Strongly Powered by AbleSci AI
更新
PDF的下载单位、IP信息已删除 (2025-6-4)

科研通是完全免费的文献互助平台,具备全网最快的应助速度,最高的求助完成率。 对每一个文献求助,科研通都将尽心尽力,给求助人一个满意的交代。
实时播报
刚刚
humingxuan完成签到,获得积分10
刚刚
陙兂完成签到,获得积分10
刚刚
狗德拜完成签到,获得积分10
1秒前
科研通AI5应助高兴的半山采纳,获得10
1秒前
1秒前
2秒前
4秒前
虚幻不弱完成签到 ,获得积分10
4秒前
4秒前
4秒前
汉堡包应助小雒雒采纳,获得10
5秒前
6秒前
emma完成签到,获得积分10
7秒前
freeway发布了新的文献求助10
7秒前
8秒前
桐桐应助刘wt采纳,获得10
8秒前
wanci应助wxr采纳,获得10
8秒前
9秒前
学医的小蜗牛完成签到 ,获得积分10
10秒前
Light发布了新的文献求助10
10秒前
小马甲应助meng采纳,获得10
10秒前
刻苦的三问应助zj采纳,获得10
10秒前
笔墨留香发布了新的文献求助10
11秒前
月亮不睡我不睡完成签到,获得积分10
11秒前
臧佳莹发布了新的文献求助10
12秒前
12秒前
Bio应助给我一支西地兰采纳,获得30
12秒前
周同学发布了新的文献求助10
14秒前
机智念桃应助123456采纳,获得10
15秒前
16秒前
情怀应助执剑燃此生采纳,获得30
16秒前
16秒前
18秒前
18秒前
莹莹发布了新的文献求助10
18秒前
杨自强发布了新的文献求助10
18秒前
19秒前
打打应助abcd采纳,获得10
19秒前
19秒前
高分求助中
Picture Books with Same-sex Parented Families: Unintentional Censorship 700
ACSM’s Guidelines for Exercise Testing and Prescription, 12th edition 500
Nucleophilic substitution in azasydnone-modified dinitroanisoles 500
不知道标题是什么 500
Indomethacinのヒトにおける経皮吸収 400
Phylogenetic study of the order Polydesmida (Myriapoda: Diplopoda) 370
Effective Learning and Mental Wellbeing 300
热门求助领域 (近24小时)
化学 材料科学 医学 生物 工程类 有机化学 生物化学 物理 内科学 纳米技术 计算机科学 化学工程 复合材料 遗传学 基因 物理化学 催化作用 冶金 细胞生物学 免疫学
热门帖子
关注 科研通微信公众号,转发送积分 3975165
求助须知:如何正确求助?哪些是违规求助? 3519595
关于积分的说明 11198781
捐赠科研通 3255912
什么是DOI,文献DOI怎么找? 1798001
邀请新用户注册赠送积分活动 877343
科研通“疑难数据库(出版商)”最低求助积分说明 806298