NYMC Faculty Publications
Systolic Blood Pressure and Outcomes in Patients With Heart Failure With Reduced Ejection Fraction
DOI
10.1016/j.jacc.2019.04.022
Journal Title
Journal of the American College of Cardiology
First Page
3054
Last Page
3063
Document Type
Article
Publication Date
June 2019
Department
Medicine
Abstract
BACKGROUND: National guidelines recommend that systolic blood pressure (SBP) in patients with heart failure with reduced ejection fraction (HFrEF) and hypertension be maintained below 130 mm Hg. OBJECTIVES: This study sought to determine associations of SBP /=130 mm Hg, balanced on 58 baseline characteristics (mean age 76 years; mean EF 28%, 45% women, 13% African American). This process was repeated in 3,946 patients, after excluding 1,669 patients (30% of 5,615) with a discharge SBP /=130 mm Hg. RESULTS: Thirty-day all-cause mortality occurred in 7% and 4% of matched patients with SBP /=130 mm Hg, respectively (hazard ratio [HR]: 1.76; 95% confidence interval [CI]: 1.24 to 2.48; p = 0.001). HRs (95% CIs) for all-cause mortality, all-cause readmission, and HF readmission at 1 year, associated with SBP /=130 mm Hg, respectively (hazard ratio [HR]: 1.76; 95% confidence interval [CI]: 1.24 to 2.48; p = 0.001). HRs (95% CIs) for all-cause mortality, all-cause readmission, and HF readmission at 1 year, associated with SBP /=130 mm Hg) were 1.50 (1.03 to 2.19; p = 0.035), and 1.19 (1.02 to 1.39; p = 0.029), respectively. CONCLUSIONS: Among hospitalized older patients with HFrEF, SBP <130 mm Hg is associated with poor outcomes. This association persisted when the analyses were repeated after excluding patients with SBP <110 mm Hg. There is an urgent need for randomized controlled trials to evaluate optimal SBP reduction goals in patients with HFrEF.
Recommended Citation
Arundel, C., Lam, P., Gill, G., Patel, S., Panjrath, G., Faselis, C., White, M., Morgan, C., Allman, R., Aronow, W., Singh, S., Fonarow, G., Ahmed, A., & Abani, C. (2019). Systolic Blood Pressure and Outcomes in Patients With Heart Failure With Reduced Ejection Fraction. Journal of the American College of Cardiology, 73 (24), 3054-3063. https://doi.org/10.1016/j.jacc.2019.04.022