BLOOD PRESSURE AT ADMISSION PREDICTS 1-YEAR OUTCOMES OF PATIENTS HOSPITALIZED FOR HEART FAILURE

Abstract

Objective: This study aimed to evaluate the association between admission blood pressure (BP) and 1-year clinical outcomes in patients hospitalized for heart failure (HF) stratified by left ventricular ejection fraction (LVEF). Design and method: In the China PEACE Prospective Heart Failure Study, 4,930 patients hospitalized primarily for HF in 52 hospitals from 20 provinces in China have been enrolled. We included 4,611 patients with available LVEF and admission BP into analysis. Heart failure with reduced ejection fraction (HFrEF), heart failure with mid-range ejection fraction (HFmrEF), and heart failure with preserved ejection fraction (HFpEF) were defined as LVEF < 40%, LVEF of 40–49%, and LVEF > = 50%, respectively. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) at admission were categorized by 10 mmHg increments. The primary outcome was the composite of all-cause death or HF readmission within 1 year after admission. The association between BP and the outcome was estimated with Cox proportional hazard models. A generalized additive model with restricted cubic splines was used to explore the possible non-linear relationship between BP and the outcome. Results: In our study, there were 1,850 (40.1%), 1035 (22.4%) and 1,726 (37.4%) patients with HFrEF, HFmrEF and HFpEF, respectively. In the multivariable analysis, compared to SBP of 120–129 mmHg, SBP > = 150 mmHg was significantly associated with a lower risk in HFrEF and SBP < 110 mmHg was significantly associated with a higher risk in HFmrEF and HFpEF (Table 1). For DBP, a significant decrease in the risk was observed for DBP > = 100 mmHg and DBP of 90–99 mmHg compared with DBP of 70–79 mmHg in HFrEF and HFpEF, respectively (Table 1). SBP and DBP were inversely and linearly associated with the primary outcome in HFrEF and HFpEF. Conversely, in HFmrEF, the association between SBP or DBP with the primary outcome was nonlinear. Conclusions: In patients hospitalized for HF, different prognostic effects of admission BP on clinical outcomes have been found by LVEF status. In HFrEF and HFpEF, the risk of clinical outcomes increased significantly only at lower BP, however, in HFmrEF, there is a nonlinear trend between BP and clinical outcomes.