Factors associated with short-term adverse events in hypertensive acute heart failure

To analyse the factors associated with adverse events in patients presenting with hypertensive acute heart failure (AHF), and to assess whether differences exist according to patient sex.

We included patients diagnosed with AHF Spanish emergency departments (EDs), with a decompensation episode and elevated systolic blood pressure (SBP) on arrival. We analysed the association between 22 independent variables and in-hospital mortality. One-year mortality and 30-day post-discharge composite adverse events (defined as ED revisit, hospitalisation, or death) were analysed.

We included 2865 AHF episodes secondary to hypertensive crisis (median age: 83 years; 60.5% women). In-hospital mortality was 5.3% and was independently associated with nine variables. Intravenous nitroglycerine administration was associated with increased in-hospital mortality (adjusted OR 1.874; 95% CI: 1.322-2.658). One-year mortality was 23.8% and was associated with eight variables (the same as in-hospital mortality, excluding valvular disease). In both cases, the strongest predictor was age ≥80 years (adjusted OR 2.195 [1.768-2.724]; adjusted HR 1.896 [1.548-2.323], respectively). The 30-day composite adverse event rate was 25.5% and was directly associated with chronic obstructive pulmonary disease (COPD) (HR 1.332; 95% CI: 1.095-1.621) and ischaemic heart disease (HR 1.202; 95% CI: 1.006-1.436), and inversely associated with hospitalisation (HR 0.781; 95% CI: 0.645-0.945). No significant interactions with sex were found for any outcome.

In hypertensive AHF, multiple factors are associated with mortality, and intravenous nitroglycerine use appears to increase risk. Post-discharge adverse events are more frequent in patients with chronic pulmonary and ischaemic heart disease. No sex-based differences were observed for any of the outcomes analysed.