BLOOD PRESSURE AT ADMISSION PREDICTS SHORT-TERM AND LONG-TERM CLINICAL OUTCOMES IN PATIENTS HOSPITALIZED FOR HEART FAILURE

Abstract

Objective: Hypertension is the leading risk factor for the development of heart failure (HF). However, the association between admission blood pressure (BP) and clinical outcomes in patients hospitalized for HF remains uncertain. The study aimed to investigate the association between BP at admission and 1-month, 6-months and 1-year clinical outcomes in patients hospitalized for HF. Design and method: This study was based on the China PEACE Prospective Heart Failure Study, which prospectively enrolled 4,930 patients hospitalized primarily for HF in 52 hospitals from 20 provinces in China. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) at admission were categorized by 10 mmHg increments. The outcomes were the composite of all-cause death or HF readmission within 1 month, 6 months and 1 year after admission. The association between BP at admission and the outcomes was estimated with Cox proportional hazards models, adjusted by age, gender, insurance type, etiology, cardiovascular risk factors, comorbidities, clinical presentation, patient reported health status and medications during hospitalization. Results: We included 4,841 HF patients with available admission BP and 1-year follow up data. The mean age was 65.1 ± 13.5 years, 37.4% were female, and the mean admission BP was 133.2 ± 24.6/81.0 ± 16.0 mmHg. Compared to patients with SBP of 120–129 mmHg, patients in the lower SBP groups had higher risk of 1-year outcome (the adjusted HR 1.41, 95% confidence interval (CI) 1.19–1.66 for SBP< 110 mmHg and HR 1.29, 95% CI 1.09–1.54 for SBP of 110–119 mmHg) (Table 1). A significant decrease in the risk of 1-year outcome was observed for DBP of 80–89 mmHg (HR 0.87, 95% CI 0.76–0.99), 90–99 mmHg (HR 0.83, 95% CI 0.71–0.98) and > = 100 mmHg (HR 0.71, 95% CI 0.59–0.85) compared with DBP of 70–79 mmHg (Table 1). Similar results for SBP and DBP for outcomes at 1 month and 6 months have been observed in Table 1. Conclusions: In patients hospitalized for HF, admission SBP and DBP predict 1-month, 6-month, and 1-year clinical outcomes after adjusting for known confounders.