Prognostic Significance of Low Systolic Blood Pressure at Discharge in Patients with Heart Failure and Preserved Ejectio
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ORIGINAL ARTICLE
Prognostic Significance of Low Systolic Blood Pressure at Discharge in Patients with Heart Failure and Preserved Ejection Fraction Shijun Li1 • Xiaoying Li1
Received: 19 April 2017 / Accepted: 13 July 2017 Ó Springer International Publishing AG 2017
Abstract Introduction Systolic blood pressure (SBP) is emerging as a predictor of outcome in chronic heart failure and low SBP has been shown to be related to higher mortality. Aim To investigate the relationship between low SBP and long-term outcome in patients with heart failure with preserved ejection fraction (HFpEF). Methods We use prospectively collected data and recruited 297 patients with chronic HFpEF to investigate the relationship between low SBP at discharge and long-term outcome. SBP was recorded at discharge and analysed in a Cox regression model. The endpoint of interest was death from any cause. Results In follow-up period, the mortality rates were 61.4% for SBP \100 mmHg, and the survival rates decreased in SBP \100 mmHg as compared with the other SBP strata by using Kaplan–Meier analysis (v2 = 22.95, log rank P \ 0.001). Compared to SBP 140–159 mmHg (reference category), the unadjusted hazard ratios for mortality were 3.29 (95% CI 1.45–7.47, P = 0.004) for SBP\100 mmHg. On multivariate analysis, adjustment for all variables, there still was an inverse relation between SBP and all cause mortality with a threshold at 100 mmHg (P = 0.002) and the adjusted hazard ratios were 3.16 (95% CI 1.15–8.68, P = 0.026) for SBP \100 mmHg. Conclusions SBP at discharge is an independent predictor of long-term outcome and affects all-cause mortality, and
& Shijun Li [email protected] 1
Department of Geriatric Cardiology, Chinese PLA General Hospital at No. 28, Fuxing Road, Beijing 100853, People’s Republic of China
SBP \100 mmHg at discharge is associated with excess long-term mortality in HFpEF. Keywords Heart failure Diastolic function Systolic blood pressure Mortality
1 Introduction Current hypertension paradigms are to guard against the development of heart failure (HF), however, once the diagnosis of HF is established, previously sought low systolic blood pressure (SBP) goals may be detrimental [1]. SBP is emerging as a predictor of outcome in chronic HF and low SBP has been shown to be related to higher mortality [2–5]. However, these studies were mostly based on heart failure and reduced ejection fraction (HFrEF) settings. According to previous studies, *50% of patients hospitalized for acute HF have preserved (C50%) left ventricular ejection fraction (LVEF) [6–9]. Some studies have investigated the association between baseline SBP and outcome in patients admitted to hospital for heart failure with preserved ejection fraction (HFpEF) [10–16]. However, SBP recordings patients in these studies were from admission but not discharge, some studies had a short follow-up and did not provide outcome data stratified by EF [10, 11], others mingled patients with worsening chronic HF and patients with new-onset HF [12]. Previous studies have e
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