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Systolic blood pressure increase in chronic heart failure associates with survival advantage
Helena Rocha1, Rita Gouveia1, Catarina Elias1
1Internal Medicine Department, Centro Hospitalar de São João, Porto, Portugal.
Insights
Systolic blood pressure (SBP) increase of at least 10 mmHg in patients with chronic heart failure (HF) over one year is linked to a significant reduction in mortality risk. Stable or decreasing SBP in HF patients indicates a poor prognosis.
Area of Science:
- Cardiology
- Clinical Medicine
- Public Health
Background:
- The prognostic impact of systolic blood pressure (SBP) variability in patients with chronic heart failure (HF) remains under-investigated.
- Understanding SBP changes is crucial for managing HF patients.
Purpose of the Study:
- To assess the impact of SBP variation on mortality in patients with chronic heart failure (HF).
Main Methods:
- Retrospective analysis of 787 adult ambulatory HF patients with left ventricular systolic dysfunction (LVSD).
- SBP variation was calculated as SBP at index visit minus SBP at 1-year visit.
- Cox regression analysis was used to determine the association between SBP variation and all-cause mortality over a 5-year follow-up period.
Main Results:
- A SBP increase of ≥10 mmHg was observed in 35.2% of patients (n=277).
- Patients with SBP increase had severe LVSD, nonischemic HF, lower baseline SBP, and higher loop diuretic use.
- A multivariate-adjusted hazard ratio of 0.61 (0.46-0.79) for all-cause mortality was found in patients with SBP increase ≥10 mmHg.
Conclusions:
- An SBP increase of ≥10 mmHg over the first year in chronic HF patients is associated with a 39% reduction in all-cause mortality risk.
- This survival benefit is independent of baseline SBP, ventricular dysfunction severity, and medication use.
- Conversely, stable or decreasing SBP in HF patients is associated with a similarly poor prognosis.
Background:
The impact of systolic blood pressure (SBP) variation on chronic heart failure (HF) is largely unknown. We assessed the impact of SBP variation in patients with chronic HF.
Methods:
This is a retrospective analysis of adult ambulatory patients with HF with left ventricular systolic dysfunction (LVSD). SBP variation = SBP at the index visit - SBP at the 1-year visit. Patients dying in the first year or with missing data concerning SBP were excluded. Patients with SBP increase ≥10 mmHg during the first year were compared with the remaining. Determinants of SBP increase were assessed by binary logistic regression analysis. The patients were followed up from the 1-year visit up to 5 years. The primary end point was all-cause mortality. A Cox regression analysis was used to determine the association of SBP variation with mortality.
Results:
We studied 787 patients (68% male), with a mean age of 70 years. SBP increased by ≥10 mmHg in 277 patients (35.2%) and remained stable or decreased in 510. Patients in whom SBP increased more often presented severe LVSD and nonischemic HF; they had lower baseline SBP and were more medicated with loop diuretics. Independent predictors of SBP increase were lower basal SBP and loop diuretic use. Patients with a SBP increase ≥10 mmHg had a crude hazard ratio (HR) of all-cause mortality of 0.74 (0.59-0.94), and the multivariate-adjusted HR was 0.61 (0.46-0.79).
Conclusions:
Patients with chronic HF with SBP increase ≥10 mmHg over the first year have a 39% reduction in the all-cause mortality risk irrespective of basal SBP, severity of ventricular dysfunction, and evidence-based drug use. Patients with SBP stability or decrease have a similarly poor prognosis.
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