BACKGROUND: Chronic heart failure (CHF) is the final stage of many heart diseases. To improve outcomes, important risk factors for adverse clinical events in the CHF population need to be identified. The aim of the present study was to delineate the influence of long-term blood pressure (BP) changes on prognosis and mortality in a real-world cohort of CHF patients. METHODS AND RESULTS: This is a retrospective longitudinal analysis. Repeated office BP measurements were scheduled during follow-up visits every 3-6 months. The primary endpoint was time to death or heart transplantation (HTx). A Cox regression with time-dependent strata was used to analyse the effect of systolic BP (SBP) values and its change during follow-up on the primary endpoint. A total of 927 patients presented with a median survival of 7.7 [95% confidence interval (CI) 6.6-9.8] years. During follow-up, 220 patients died and 70 patients underwent HTx. The BP stratum with the most stable values showed the best survival. Blood pressure changes with an increase or decrease greater than ±10 mmHg per year led to a significantly worse outcome [hazard ratio (HR) 1.8 and 2.0, respectively]. The stratum with the lowest SBP levels (<90 mmHg) had the highest mortality. Multiple regression analysis showed a HR factor of 17 (95% CI 9.7-29) in comparison with the stratum with SBP ≥130 mmHg. CONCLUSION: Low SBP (<90 mmHg) and pronounced long-term changes in SBP were associated with poor survival in patients with CHF. Additional prospective studies are warranted to further specify optimal BP targets in patients with CHF.
BACKGROUND:Chronic heart failure (CHF) is the final stage of many heart diseases. To improve outcomes, important risk factors for adverse clinical events in the CHF population need to be identified. The aim of the present study was to delineate the influence of long-term blood pressure (BP) changes on prognosis and mortality in a real-world cohort of CHFpatients. METHODS AND RESULTS: This is a retrospective longitudinal analysis. Repeated office BP measurements were scheduled during follow-up visits every 3-6 months. The primary endpoint was time to death or heart transplantation (HTx). A Cox regression with time-dependent strata was used to analyse the effect of systolic BP (SBP) values and its change during follow-up on the primary endpoint. A total of 927 patients presented with a median survival of 7.7 [95% confidence interval (CI) 6.6-9.8] years. During follow-up, 220 patients died and 70 patients underwent HTx. The BP stratum with the most stable values showed the best survival. Blood pressure changes with an increase or decrease greater than ±10 mmHg per year led to a significantly worse outcome [hazard ratio (HR) 1.8 and 2.0, respectively]. The stratum with the lowest SBP levels (<90 mmHg) had the highest mortality. Multiple regression analysis showed a HR factor of 17 (95% CI 9.7-29) in comparison with the stratum with SBP ≥130 mmHg. CONCLUSION: Low SBP (<90 mmHg) and pronounced long-term changes in SBP were associated with poor survival in patients with CHF. Additional prospective studies are warranted to further specify optimal BP targets in patients with CHF.
Authors: Louise Y Sun; Jack V Tu; Thais Coutinho; Michele Turek; Fraser D Rubens; Lisa McDonnell; Heather Tulloch; Anan Bader Eddeen; Lisa M Mielniczuk Journal: CMAJ Date: 2018-07-16 Impact factor: 8.262
Authors: P-L Kuo; J A Schrack; M D Shardell; M Levine; A Z Moore; Y An; P Elango; A Karikkineth; T Tanaka; R de Cabo; L M Zukley; M AlGhatrif; C W Chia; E M Simonsick; J M Egan; S M Resnick; L Ferrucci Journal: J Intern Med Date: 2020-02-27 Impact factor: 13.068
Authors: Lauren G Gilstrap; Lynne W Stevenson; Roy Small; Ron Parambi; Rose Hamershock; Jeffrey Greenberg; Christina Carr; Roya Ghazinouri; Lisa Rathman; Elizabeth Han; Mandeep R Mehra; Akshay S Desai Journal: J Am Heart Assoc Date: 2018-08-07 Impact factor: 5.501
Authors: Louise Y Sun; Lisa M Mielniczuk; Peter P Liu; Rob S Beanlands; Sharon Chih; Ross Davies; Thais Coutinho; Douglas S Lee; Peter C Austin; Anan Bader Eddeen; Jack V Tu Journal: BMJ Open Date: 2020-11-26 Impact factor: 2.692