Abstract
Although systolic blood pressure (SBP) is routinely considered when treating acute heart failure (HF), diastolic blood pressure (DBP) is hardly been assessed in the situation. There are no previous studies regarding the predictive value of DBP in elderly patients with HF with preserved ejection fraction (HFpEF) in Japan. This study aimed to investigate the prognostic significance of DBP in patients with acute decompensated HFpEF. We analyzed data of all HFpEF patients admitted to Shinonoi General Hospital for HF treatment between July 2016 and December 2018. We excluded patients with acute coronary syndrome and severe valvular disease. Patients were divided into two groups according to their median DBP; the low DBP group (DBP ≤ 77 mmHg, n = 106) and the high DBP group (DBP > 77 mmHg, n = 100). The primary outcome was HF readmission. In 206 enrolled patients (median 86 years), during a median follow-up of 302 days, the primary outcome occurred in 48 patients. The incidence of HF readmission was significantly higher in the low DBP group (33.0% vs 18.5%, p = 0.024). In Kaplan–Meier analysis, low DBP predicted HF readmission (Log-rank test, p = 0.013). In Cox proportional hazard analysis, low DBP was an independent predictor of HF readmission after adjustment for age, sex, SBP, hemoglobin, serum albumin, serum creatinine, B-type natriuretic peptide, renin-angiotensin system inhibitors, calcium channel blockers, left ventricular ejection fraction, coronary artery disease, and whether they live alone (hazard ratio, 2.229; 95% confidence interval, 1.021–4.867; p = 0.044). Low DBP predicted HF readmission in patients with HFpEF.
Highlights
Improvements in cardiovascular survival rates and progressive aging of the population have led to an increase in elderly patients with heart failure with preserved ejection fraction (HFpEF) [1,2,3,4]
We aimed to identify the prognostic significance of low diastolic blood pressure (DBP) in elderly patients with acute decompensated HFpEF in a retrospective cohort study
In the multivariate Cox proportional hazards analysis, the low DBP group was an independent predictor of HF readmission after adjustment for age, sex, systolic blood pressure (SBP), hemoglobin, serum albumin, serum creatinine, B-type natriuretic peptide (BNP), renin-angiotensin system inhibitors (RASi), calcium channel blockers (CCB), left ventricular ejection fraction (LVEF), coronary artery disease (CAD), and whether they live alone (Table 3)
Summary
Improvements in cardiovascular survival rates and progressive aging of the population have led to an increase in elderly patients with heart failure with preserved ejection fraction (HFpEF) [1,2,3,4]. We encounter elderly patients with low diastolic blood pressure (DBP) in HFpEF. The relation between DBP and cardiovascular events could be attributed to the decline in DBP as a consequence of stiffing of the large arteries in elderly patients with HFpEF. Systolic blood pressure (SBP) is routinely considered when treating acute heart failure [6], DBP is hardly been assessed in the situation. Several recent studies have reported the association between low DBP and adverse outcomes in stable HFpEF without adjusting for SBP [7, 8].
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have