Prognostic Significance of Low Systolic Blood Pressure at Discharge in Patients with Heart Failure and Preserved Ejection Fraction

Abstract

Systolic blood pressure (SBP) is emerging as a predictor of outcome in chronic heart failure and low SBP has been shown to be related to higher mortality. To investigate the relationship between low SBP and long-term outcome in patients with heart failure with preserved ejection fraction (HFpEF). We use prospectively collected data and recruited 297 patients with chronic HFpEF to investigate the relationship between low SBP at discharge and long-term outcome. SBP was recorded at discharge and analysed in a Cox regression model. The endpoint of interest was death from any cause. In follow-up period, the mortality rates were 61.4% for SBP <100mmHg, and the survival rates decreased in SBP <100mmHg as compared with the other SBP strata by using Kaplan-Meier analysis (χ 2=22.95, log rank P<0.001). Compared to SBP 140-159mmHg (reference category), the unadjusted hazard ratios for mortality were 3.29 (95% CI 1.45-7.47, P=0.004) for SBP <100mmHg. On multivariate analysis, adjustment for all variables, there still was an inverse relation between SBP and all cause mortality with a threshold at 100mmHg (P=0.002) and the adjusted hazard ratios were 3.16 (95% CI 1.15-8.68, P=0.026) for SBP <100mmHg. SBP at discharge is an independent predictor of long-term outcome and affects all-cause mortality, and SBP <100mmHg at discharge is associated with excess long-term mortality in HFpEF.