4.5 Article

Systolic blood pressure on admission in acute decompensated heart failure with preserved ejection fraction

Journal

ESC HEART FAILURE
Volume 8, Issue 4, Pages 3145-3155

Publisher

WILEY PERIODICALS, INC
DOI: 10.1002/ehf2.13420

Keywords

Heart failure; Blood pressure; Prognosis

Funding

  1. Roche Diagnostics K.K. (Minato-ku, Tokyo, Japan)
  2. Fuji Film Toyama Chemical Co. Ltd. (Chuo-ku, Tokyo, Japan)

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The study found that patients with preserved admission SBP had a higher risk for adverse outcomes of cardiac death and heart failure re-hospitalization in HFpEF. Compared to patients with elevated admission SBP, those with preserved SBP had a higher risk of poor prognosis.
Aims: The prognostic importance of admission systolic blood pressure (SBP) in heart failure with preserved ejection fraction (HFpEF) is elusive. We aimed to clarify the pathophysiological differences between patients categorized with admission SBP among HFpEF patients. Methods and results: We studied 1008 inpatients from PURSUIT-HFpEF, a multicentre prospective observational registry. We classified patients as having elevated (>140 mmHg), preserved (90-140 mmHg), or low (<90 mmHg) admission SBP. Most cases had elevated (n = 584) or preserved (n = 420) SBP; the four cases with low SBP were excluded. Univariable Cox regression testing revealed that preserved SBP patients had a higher risk of a composite of cardiac death and heart failure re-hospitalization [hazard ratio (HR) 1.48, 95% confidence interval (CI) 1.14-1.92, P = 0.0035] than elevated SBP patients. In multivariable Cox regression models, while prior heart failure hospitalization (HR 1.36, 95% CI 1.01-2.84, P = 0.0453), atrial fibrillation (HR 1.82, 95% CI 1.10-2.99, P = 0.0209), and N-terminal pro-B-type natriuretic peptide (HR 1.94, 95% CI 1.10-3.43, P = 0.0229) at discharge were significantly associated with adverse outcomes in elevated SBP patients, N-terminal pro-B-type natriuretic peptide (HR 2.06, 95% CI 1.04-4.07, P = 0.0373) and right ventricular-pulmonary artery uncoupling reflected by the tricuspid annular plane systolic excursion/pulmonary artery systolic pressure ratio (HR 0.19, 95% CI 0.05-0.65, P = 0.0075) at discharge were significant prognostic factors in preserved SBP patients. Conclusions: Patients with preserved admission SBP had significant higher risks for adverse outcomes than those with elevated SBP in HFpEF. Tricuspid annular plane systolic excursion/pulmonary artery systolic pressure was the distinctive prognostic factor between the two groups.

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