CLOROTIC(襻利尿剂与噻嗪类药物联合治疗失代偿性心力衰竭)临床试验的临床特征和结果中的性别差异

IF 2.3 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL
A. Conde-Martel , J.C. Trullàs , J.L. Morales-Rull , J. Casado , M. Carrera-Izquierdo , M. Sánchez-Marteles , P. Llácer , P. Salamanca-Bautista , L. Manzano , F. Formiga
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引用次数: 0

摘要

目的在CLOROTIC试验中,在呋塞米基础上加用氢氯噻嗪(HCTZ)可改善急性心力衰竭(AHF)患者的利尿反应。我们的目的是评估不同性别患者的临床特征和结果是否存在差异。方法这是一项对 CLOROTIC 试验的事后分析,该试验包括 230 名急性心力衰竭患者,他们在静脉注射呋塞米方案的同时随机接受 HCTZ 或安慰剂治疗。主要和次要结果包括随机化后72和96小时体重和患者报告的呼吸困难的变化、利尿剂反应指标以及30和90天的死亡率/再住院率。研究还评估了性别对主要、次要和安全性结果的影响。女性年龄较大,左心室射血分数较高。男性患缺血性心肌病和慢性阻塞性肺病的人数较多,钠尿肽的数值也较高。与安慰剂相比,在呋塞米基础上加用 HCTZ 的 72/96 小时体重减轻幅度最大,利尿反应指标更好,24 小时利尿率更高,但性别差异不显著(所有交互作用的 P 值均不显著)。女性肾功能恶化的发生率(OR:8.68;95% CI:3.41-24.63)高于男性(OR:2.5;95% CI:0.99-4.87),P = 0.027。结论 在静脉注射呋塞米的基础上添加 HCTZ 是改善 AHF 利尿反应的有效策略,与性别无关,但女性肾功能恶化的发生率更高。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Diferencias en función del sexo en las características clínicas y resultados del ensayo clínico CLOROTIC (combinación de diuréticos de asa con tiazidas en la insuficiencia cardiaca descompensada)

Aims

The addition of hydrochlorothiazide (HCTZ) to furosemide improved the diuretic response in patients with acute heart failure (AHF) in the CLOROTIC trial. Our aim was to evaluate if there were differences in clinical characteristics and outcomes according to sex.

Methods

This is a post hoc analysis of the CLOROTIC trial, including 230 patients with AHF randomized to receive HCTZ or placebo in addition to an intravenous furosemide regimen. The primary and secondary outcomes included changes in weight and patient-reported dyspnoea 72 and 96 h after randomization, metrics of diuretic response and mortality/rehospitalizations at 30 and 90 days. The influence of sex on primary, secondary and safety outcomes was evaluated.

Results

One hundred and eleven (48%) women were included in the study. Women were older and had higher values of left ventricular ejection fraction. Men had more ischemic cardiomyopathy and chronic obstructive pulmonary disease and higher values of natriuretic peptides. The addition of HCTZ to furosemide was associated to a greatest weight loss at 72/96 h, better metrics of diuretic response and higher 24-h diuresis compared to placebo without significant differences according to sex (all P-values for interaction were not significant). Worsening renal function occurred more frequently in women (OR: 8.68; 95% CI: 3.41-24.63) than men (OR: 2.5; 95% CI: 0.99-4.87), P = .027. There were no differences in mortality or rehospitalizations at 30/90 days.

Conclusion

Adding HCTZ to intravenous furosemide is an effective strategy to improve diuretic response in AHF with no difference according to sex, but worsening renal function was more frequent in women.

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来源期刊
Revista clinica espanola
Revista clinica espanola 医学-医学:内科
CiteScore
4.40
自引率
6.90%
发文量
73
审稿时长
28 days
期刊介绍: Revista Clínica Española published its first issue in 1940 and is the body of expression of the Spanish Society of Internal Medicine (SEMI). The journal fully endorses the goals of updating knowledge and facilitating the acquisition of key developments in internal medicine applied to clinical practice. Revista Clínica Española is subject to a thorough double blind review of the received articles written in Spanish or English. Nine issues are published each year, including mostly originals, reviews and consensus documents.
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