Low blood pressure and preserved systolic function in elders with heart failure

Prognostic Significance of Low Systolic Blood Pressure at Discharge in Patients with Heart Failure and Preserved Ejection Fraction

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 (χ ² = 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 SBP <100 mmHg at discharge is associated with excess long-term mortality in HFpEF.