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Differential prognostic effect of systolic blood pressure on mortality according to left‐ventricular function in patients with acute heart failure
Author(s) -
Núñez Julio,
Núñez Eduardo,
Fonarow Gregg C.,
Sanchis Juan,
Bodí Vicent,
BertomeuGonzález Vicente,
Miñana Gema,
Merlos Pilar,
BertomeuMartínez Vicente,
Redón Josep,
Chorro Francisco J.,
Llàcer Angel
Publication year - 2010
Publication title -
european journal of heart failure
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.149
H-Index - 133
eISSN - 1879-0844
pISSN - 1388-9842
DOI - 10.1093/eurjhf/hfp176
Subject(s) - ejection fraction , medicine , cardiology , heart failure , blood pressure , proportional hazards model , stroke volume
Aims To evaluate the relationship between systolic blood pressure (SBP) and long‐term mortality in patients with acute heart failure (AHF) stratified by ejection fraction (LVEF): reduced (≤40%) vs. preserved (≥50%). Methods and results We studied 1049 consecutive patients admitted with AHF. Systolic blood pressure was determined in the emergency department. Left‐ventricular ejection fraction was categorized as ≤40% ( n = 288), 41–49% ( n = 174), or ≥50% ( n = 587). Cox regression analysis was used for multivariable analysis. Mean age and SBP were 73 ± 11 years and 150 ± 36 mmHg, respectively. During a median follow‐up of 18 months, 290 deaths (33.1%) were identified. Higher SBP was associated with lower mortality. In multivariable analysis, a differential effect of SBP across LVEF status was documented ( P ‐value for interaction = 0.036). In linear models, SBP was shown to be inversely related with mortality in both groups (per 10 mmHg decrease): HR (LVEF ≥ 50%) : 1.06, CI 95% = 1.01–1.11; P = 0.016, and HR (LVEF ≤ 40%) : 1.16, 95% CI = 1.08–1.25; P < 0.001). When SBP was modelled with restrictive cubic splines, an inverse and almost linear relationship with mortality was shown in patients with LVEF ≤40% ( P < 0.001), whereas in patients with LVEF ≥50%, SBP followed a J‐shape curve. Conclusion In patients with AHF, SBP showed a differential prognostic effect on mortality according to LVEF status; when LVEF was ≤40%, SBP was linearly and inversely associated with mortality. Conversely, in patients with LVEF ≥50% this relationship showed a J‐shape pattern.