PS-BPC05-2: ADMISSION AND DISCHARGE BLOOD PRESSURE INFLUENCE MEDICAL PRESCRIPTION AND CLINICAL OUTCOMES OF PATIENTS WITH DECOMPENSATED HEART FAILURE

Abstract

Background: There has been no study evaluating whether admission blood pressure (BP) influences medical treatment and clinical outcomes in acute decompensated heart failure patients. Methods: We analyzed the data form Korean Acute Heart Failure (KorHF) Registry. A total of 3,200 acute decompensated heart failure patients were included in the registry. We investigated the association of initial blood pressure at admission and clinical outcomes and prescription of ACEI, ARB and beta-bolcker(BB). The primary outcome was composite of mortality and readmission during 1-year after hospital discharge. Results: Admission systolic (SBP) and diastolic BP (DBP) increase was associated with decrease in primary outcomes (by 1mmHg increase of SBP, crude hazard ratio [HR] 0.9963, 95% CI: 0.9943–0.9982, p < 0.0001 and by 1mmHg increase of DBP, crude HR 0.99, 95% CI: 0.9867–0.9932, p < 0.0001). By multiple regression analysis DBP was an independent risk factors of mortality and re-hospitalization (HR 0.9927, 95% CI 0.9867–0.9988, p < 0.0196), but SBP was not. Age, history of heart failure, hypertension, cholesterol level and ACE/ARB use were also associated with primary outcomes. The cut-off value of SBP and DBP for increasing clinical outcomes were 118.5 mmHg (sensitivity 0.3965, specificity 0.6727) and 78.5mmHg (sensitivity 0.5682, specificity 0.5228), respectively by ROC curve. The SBP < 118.5 mmHg and DBP < 78.5mmHg were independent predictor for primary outcomes (adjusted HR 1.33, 95% CI 1.15–1.54, p < 0.0001 and adjusted HR 1.23, 95% CI 1.12–1.48, p = 0.0004, respectively). The cut off SBP/ DBP value of not using in-hospital ACE/ARB/BB were 129.5/80.5mmHg. DBP of 80.5mmHg was an independent determinants of not prescribing the drugs (adjusted OR 0.755, 95% CI: 0.582–0.977, p = 0.0329). Both lower SBP (< 129.5) and DBP (< 80.5mmHg) combined with no use of the drugs were independent predictor of poor clinical outcomes at 1-year. (adjusted HR 1.677, 95% CI: 1.380–2.037, p < 0.0001 and adjusted HR 1.653, 95% CI: 1.355–2.017, P < 0.0001, respectively) Conclusions: Lower blood pressure at admission increase mortality, re-hospitalization at 1-year and decrease in-hospital prescription of ACE/ARB and BB in patients with acute decompensated heart failure. The cut-off value of SBP/DBP for primary outcome was 118.5/78.5 mmHg and that for use of ACE/ARB/BB was 129.5/80.5mmHg.