Admission blood pressure and mortality in acute aortic dissection: Southwest China multicenter retrospective cohort study

The combined effect of admission systolic (SBP) and diastolic blood pressure (DBP) on short- and long-term all-cause mortality in patients with acute aortic dissection (AAD) remains insufficiently characterized. This retrospective cohort study investigated these associations to identify potential blood pressure thresholds linked to minimized mortality risk. We utilized restricted cubic splines (RCS) to characterize nonlinear associations, identifying specific BP levels (nadirs) associated with the lowest risk of mortality. Segmented analysis was employed to assess linear relationships flanking these nadirs, and multivariable Cox regression models were applied to evaluate the impact of different BP ranges after adjusting for potential confounders. Our results revealed a significant J-shaped correlation for admission SBP and DBP regarding long-term mortality. Mortality risks escalated at SBP levels departing from a nadir of 143.4 mmHg and at DBP departing from 83.7 mmHg. Specifically, an admission SBP/DBP range of 130–160/80–88 mmHg was associated with the lowest long-term all-cause mortality risk, serving as the risk-nadir interval in this cohort. Other independent predictors of mortality included advanced age, myocardial infarction, higher heart rate, history of heart bypass, elevated NT-proBNP and hsTNT, while type B AAD, normal heart rhythm and surgery within 24 h were protective factors. In conclusion, admission SBP and DBP exhibit significant nonlinear associations (J-shaped) with long-term all-cause mortality in AAD. The identified 130–160/80–88 mmHg range represents a potential reference interval for admission hemodynamic management, while acknowledging the need for validation in diverse clinical settings.