119 Blood pressure in acute heart failure: relation to mortality at follow up

Abstract

Background: Acute heart failure (HF) is a very common diagnose among hospitaJised patients in the emergency ward. Hypertension is a risk factor for the development of HF but in patients with established HF an inverse relation between blood pressure (BP) and mortality has been shown. It is not known to what extent changes in blood pressure during hospital care for heart failure influence prognosis. Aims: To investigate the relationship between mortality and BP on admission and at discharge in patients who had a hospitaJisation for acute HF. Method and results: 217 consecutive patients (mean age 79 years, 108 men and 109 women) admitted to the medical emergency ward at Karolinska hospital with acute heart failure during the year 2004, were included. Fifty-three percent had de-novo acute HF and 47% a decompensation of chronic HE Alter a median observation time of 421 days (0-700) all cause mortality was 33%. Average BP:s on admission and discharge were 145+32/85+18 and 131+25/76+14 mm Hg (p<0.001/p<0.001) respectively. All cause mortality was predicted by a lower SBP both on admission (p<0.001) and at discharge (p<0.05) and by a lower DBP on admission (p<0.001) but not at discharge. A decrease in DBP (p<0.05) but not SBP during hospitaJisation was a predictor of mortality. Conclusion: In patients hospitaJised for acute heart failure blood pressure on admission and the change of blood pressure during hospitaJisation is a predictor for mortality. The patho-physiological reasons for this and the therapeutic consequences need to be further evaluated.