Journal
JACC-HEART FAILURE
Volume 9, Issue 12, Pages 890-903Publisher
ELSEVIER SCI LTD
DOI: 10.1016/j.jchf.2021.07.001
Keywords
acute heart failure; blood pressure; renal dysfunction
Categories
Funding
- Novartis
- American Heart Association
- National Institutes of Health
- Rocket Pharma
- Abbott Laboratories
- Amgen
- Celyad
- Cirius Therapeutics
- Roche Diagnostics
- Sanofi
- Windtree Therapeutics
- National Heart, Lung, and Blood Institute
- Bayer Merck
- Cytokinetics
- Servier
- Medtronic
- Vifor
- Boehringer Ingelheim
- Bayer
- Bristol Myers Squibb
- Roche
- Patient-Centered Outcomes Research Institute
- Agency for Healthcare Research and Quality, OrthoDiagnostics
- Vifor Pharma
- MyoKardia
- Novo Nordisk
- AbbVie
- AstraZeneca
- EBR Systems
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In patients hospitalized for acute heart failure, a significant early drop in systolic blood pressure was associated with increased risk for worsening renal function, worsening heart failure, and 180-day cardiovascular death. However, the association between systolic blood pressure drop and prognosis was not influenced by worsening renal function.
OBJECTIVES The aim of this study was to investigate the association between systolic blood pressure (SBP) drop, worsening renal function (WRF), and prognosis in patients with acute heart failure (AHF). BACKGROUND A large drop in SBP early after hospital admission for AHF might be associated with increased risk for WRF and prognosis. However, there is a paucity of data regarding the interaction between WRF and a drop in SBP on clinical outcomes. METHODS A post hoc analysis among 6,544 patients with AHF enrolled in the RELAX-AHF-2 (Relaxin in Acute Heart Failure-2) trial was performed. Blood pressure was uniformly and repetitively measured. Peak SBP drop was defined as the difference between baseline SBP and lowest SBP documented during the first 48 hours. WRF was defined by an increase in serum creatinine of $0.3 mg/dL from baseline to day 5. RESULTS Peak SBP drop was independently associated with a higher risk for WRF (HR: 1.11 per 10 mm Hg SBP drop; P < 0.001), 5-day worsening heart failure (HR: 1.12 per 10 mm Hg SBP drop; P = 0.006), and 180-day cardiovascular death (HR: 1.09 per 10 mm Hg SBP drop; P = 0.026) after adjustment for potential confounders including baseline SBP. There was no interaction between the prognostic value of early SBP drop according to the presence or absence of WRF. CONCLUSIONS In patients hospitalized for AHF, a greater early drop in SBP was associated with a higher incidence of WRF, worsening heart failure, and an increased risk for 180-day cardiovascular death. However, the association between SBP drop and prognosis was not influenced by WRF. (Efficacy, Safety and Tolerability of Serelaxin When Added to Standard Therapy in AHF [RELAX-AHF-2]; NCT01870778) (J Am Coll Cardiol HF 2021;9:890-903) (c) 2021 by the American College of Cardiology Foundation.
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