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Prognostic value of long-term blood pressure changes in patients with chronic heart failure
Florian A Schmid1, Oliver Schlager1, Philipp Keller1
1University Heart Centre, Cardiology, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland.
Insights
Low systolic blood pressure (SBP) and significant long-term SBP fluctuations worsen survival in chronic heart failure (CHF) patients. Stable blood pressure is key for better outcomes in CHF management.
Area of Science:
- Cardiology
- Clinical Research
- Public Health
Background:
- Chronic heart failure (CHF) represents the advanced stage of various cardiac conditions.
- Identifying risk factors for adverse events is crucial for improving CHF patient outcomes.
- Understanding the impact of blood pressure (BP) variability is essential in managing CHF.
Purpose of the Study:
- To investigate the effect of long-term blood pressure (BP) changes on prognosis and mortality in a real-world CHF cohort.
- To determine the association between systolic blood pressure (SBP) levels and changes over time with clinical outcomes.
- To identify optimal BP management strategies for CHF patients.
Main Methods:
- Retrospective longitudinal analysis of 927 CHF patients.
- Repeated office BP measurements every 3-6 months during follow-up.
- Cox regression with time-dependent strata to analyze SBP and its changes concerning mortality or heart transplantation (HTx).
Main Results:
- Median survival was 7.7 years; 220 deaths and 70 HTx occurred.
- Stable BP levels correlated with the best survival rates.
- Annual SBP changes > ±10 mmHg significantly worsened outcomes (HR 1.8-2.0).
- Lowest SBP levels (<90 mmHg) showed the highest mortality (HR 17 vs. SBP ≥130 mmHg).
Conclusions:
- Low SBP (<90 mmHg) and significant long-term SBP fluctuations are linked to poor survival in CHF.
- These findings highlight the prognostic importance of BP stability in CHF.
- Further prospective studies are needed to define optimal BP targets for CHF patients.
Background:
Chronic heart failure (CHF) is the final stage of many heart diseases. To improve outcomes, important risk factors for adverse clinical events in the CHF population need to be identified. The aim of the present study was to delineate the influence of long-term blood pressure (BP) changes on prognosis and mortality in a real-world cohort of CHF patients.
Methods And Results:
This is a retrospective longitudinal analysis. Repeated office BP measurements were scheduled during follow-up visits every 3-6 months. The primary endpoint was time to death or heart transplantation (HTx). A Cox regression with time-dependent strata was used to analyse the effect of systolic BP (SBP) values and its change during follow-up on the primary endpoint. A total of 927 patients presented with a median survival of 7.7 [95% confidence interval (CI) 6.6-9.8] years. During follow-up, 220 patients died and 70 patients underwent HTx. The BP stratum with the most stable values showed the best survival. Blood pressure changes with an increase or decrease greater than ±10 mmHg per year led to a significantly worse outcome [hazard ratio (HR) 1.8 and 2.0, respectively]. The stratum with the lowest SBP levels (<90 mmHg) had the highest mortality. Multiple regression analysis showed a HR factor of 17 (95% CI 9.7-29) in comparison with the stratum with SBP ≥130 mmHg.
Conclusion:
Low SBP (<90 mmHg) and pronounced long-term changes in SBP were associated with poor survival in patients with CHF. Additional prospective studies are warranted to further specify optimal BP targets in patients with CHF.
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Monitoring Both Arms:
Monitoring BP in both arms during the initial assessment is advisable, as the systolic value may differ by five to ten mm Hg between arms. For subsequent BP assessments, use the arm with the higher reading.