Systolic Blood Pressure on Admission and Mortality in Patients Hospitalized With Acute Heart Failure: Observations From the Gulf Acute Heart Failure Registry
Restricted accessResearch articleFirst published online August, 2017
Systolic Blood Pressure on Admission and Mortality in Patients Hospitalized With Acute Heart Failure: Observations From the Gulf Acute Heart Failure Registry
We investigated the role of systolic blood pressure (SBP) in relation to in-hospital and postdischarge mortality in patients admitted with acute heart failure (AHF). The SBP of 4848 patients aged ≥18 years admitted with AHF was categorized into 5 groups: ≤90, 91 to 119, 120 to 139, 140 to 161, and >161 mm Hg. After adjusting for several confounders, multivariate logistic regression models showed that admission SBP was a significant predictor of mortality among both patients with preserved left ventricular function (defined as left ventricular ejection fraction [LVEF] ≥40%) and patients with left ventricular dysfunction (LVEF <40%). The adjusted odds ratios of in-hospital, 3-month, and 1-year mortality in the lowest SBP groups were 7.06 (95% confidence interval [CI]: 3.28-15.20; P < .001), 2.59 (95% CI: 1.35-4.96; P = .004), and 3.10 (95% CI: 2.04-4.72; P < .001) times the odds in the highest admission group (SBP > 161 mm Hg), respectively. We conclude that low admission SBP is an independent predictor of mortality in patients with AHF. The higher the admission SBP, the better the prognosis, regardless of age or LVEF.
Global Burden of Disease Study Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2015;386(9995):743–800.
2.
BinanayCCaliffRMHasselbladV; ESCAPE Investigators and ESCAPE Study Coordinators. Evaluation study of congestive heart failure and pulmonary artery catheterization effectiveness: the ESCAPE trial. JAMA. 2005;294(13):1625–1633.
3.
TeerlinkJRMcMurrayJJBourgeRC; VERITAS Investigators. Tezosentan in patients with acute heart failure: design of the Value of Endothelin Receptor Inhibition with Tezosentan in Acute heart failure Study (VERITAS). Am Heart J. 2005;150(1):46–53.
4.
PackerMColucciWFisherL; REVIVE Heart Failure Study Group. Effect of levosimendan on the short-term clinical course of patients with acutely decompensated heart failure. JACC Heart Fail. 2013;1(2):103–111.
5.
CuffeMSCaliffRMAdamsKFJr; Outcomes of a Prospective Trial of Intravenous Milrinone for Exacerbations of Chronic Heart Failure (OPTIME-CHF) Investigators. Short-term intravenous milrinone for acute exacerbation of chronic heart failure: a randomized controlled trial. JAMA. 2002;287(12):1541–1547.
6.
Publication Committee for the VMAC Investigators. Intravenous nesiritide vs nitroglycerin for treatment of decompensated congestive heart failure: a randomized controlled trial. JAMA. 2002;287(12):1531–1540.
7.
MebazaaANieminenMSPackerM; SURVIVE Investigators. Levosimendan vs dobutamine for patients with acute decompensated heart failure: the SURVIVE Randomized Trial. JAMA. 2007;297(17):1883–1891.
8.
GheorghiadeMAbrahamWTAlbertNM; OPTIMIZE-HF Investigators and Coordinators. Systolic blood pressure at admission, clinical characteristics, and outcomes in patients hospitalized with acute heart failure. JAMA. 2006;296(18):2217–2226.
9.
AdamsKFJrFonarowGCEmermanCL; ADHERE Scientific Advisory Committee and Investigators. Characteristics and outcomes of patients hospitalized for heart failure in the United States: rationale, design, and preliminary observations from the first 100,000 cases in the Acute Decompensated Heart Failure National Registry (ADHERE). Am Heart J. 2005;149(2):209–216.
10.
KajimotoKSatoNTakanoT, investigators of the Acute Decompensated Heart Failure Syndromes (ATTEND) Registry. Association of age and baseline systolic blood pressure with outcomes in patients hospitalized for acute heart failure syndromes. Int J Cardiol. 2015;191:100–106.
11.
KajimotoKSatoNSakataYTakanoT; Acute Decompensated Heart Failure Syndromes (ATTEND) Investigators. Relationship between systolic blood pressure and preserved or reduced ejection fraction at admission in patients hospitalized for acute heart failure syndromes. Int J Cardiol. 2013;168(5):4790–4795.
12.
SulaimanKJPandurangaPAl-ZakwaniI. Rationale, design, methodology and hospital characteristics of the first Gulf Acute Heart Failure Registry (Gulf CARE). Heart Views. 2014;15(1):6–12.
13.
DicksteinKCohen-SolalAFilippatosG; ESC Committee for Practice Guidelines (CPG). ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2008: the Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2008 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association of the ESC (HFA) and endorsed by the European Society of Intensive Care Medicine (ESICM). Eur Heart J. 2008;29(19):2388–2442.
14.
RadfordMJArnoldJMBennettSJ; American College of Cardiology; American Heart Association Task Force on Clinical Data Standards; American College of Chest Physicians; International Society for Heart and Lung Transplantation; Heart Failure Society of America. ACC/AHA key data elements and definitions for measuring the clinical management and outcomes of patients with chronic heart failure: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Data Standards (Writing Committee to Develop Heart Failure Clinical Data Standards): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Failure Society of America. Circulation. 2005;112(12):1888–1916.
15.
SivagnanamKChaudariDLopezPSutherlandMERamuVK. “Bath salts” induced severe reversible cardiomyopathy. Am J Case Rep. 2013;14:288–291.
16.
WabeNT. Chemistry, pharmacology, and toxicology of khat (Catha edulis forsk): a review. Addict Health. 2011;3(3-4):137–149.
17.
ChobanianAVBakrisGLBlackHR; Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. National Heart, Lung, and Blood Institute; National High Blood Pressure Education Program Coordinating Committee. Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension. 2003;42(6):1206–1252.
18.
LemeshowSHosmerDWJr. A review of goodness of fit statistics for use in the development of logistic regression models. Am J Epidemiol. 1982;115(1):92–106.
19.
HanleyJAMcNeilBJ. The meaning and use of the area under a receiver operating characteristic (ROC) curve. Radiology. 1982;143(1):29–36.
20.
ChioncelOVinereanuDBubenekSAmbrosyAMacarieCGheorghiadeM. Adverse in-hospital outcomes by systolic blood pressure at admission in patients hospitalized with acute heart failure syndromes: data from RO-AHFS registry. J Card Fail. 2012;18(suppl 8):S89.
21.
VidanMTBuenoHWangY. The relationship between systolic blood pressure on admission and mortality in older patients with heart failure. Eur J Heart Fail. 2010;12(2):148–155.
22.
RosmanYKopelEShlomaiGGoldenbergIGrossmanE. The association between admission systolic blood pressure of heart failure patients with preserved systolic function and mortality outcomes. Eur J Intern Med. 2015;26(10):807–812.
23.
BuiciucORusinaruDLevyF. Low systolic blood pressure at admission predicts long-term mortality in heart failure with preserved ejection fraction. J Card Fail. 2011;17(11):907–915.
24.
BhatiaRSTuJVLeeDS. Outcome of heart failure with preserved ejection fraction in a population-based study. N Engl J Med. 2006;355(3):260–269.
25.
FonarowGCAdamsKFJrAbrahamWTYancyCWBoscardinWJ; Adhere Scientific Advisory Committee Study Group Investigators. Risk stratification for in-hospital mortality in acutely decompensated heart failure: classification and regression tree analysis. JAMA. 2005;293(5):572–580.
26.
PatelKFonarowGCAhmedM. Calcium channel blockers and outcomes in older patients with heart failure and preserved ejection fraction. Circ Heart Fail. 2014;7(6):945–952.
27.
GheorghiadeMZannadFSopkoG; International Working Group on Acute Heart Failure Syndromes. Acute heart failure syndromes: current state and framework for future research. Circulation. 2005;112(25):3958–3968.
