title: A low pulse pressure is an independent predictor of mortality in heart failure: data from a large nationwide cardiology database (IN-CHF Registry).
abstract: BACKGROUND
  A high pulse pressure (PP) predicts cardiovascular mortality in hypertension and in the elderly. We analyzed the data from the Italian Network of Congestive Heart Failure Registry to test the prognostic role of PP in patients with heart failure.
  
  
  METHODS
  A total of 8660 patients with heart failure (mean age 64 +/- 12 years, 73% male) were divided into four groups according to their PP (< 40, 40-49, 50-59, and > or = 60 mmHg), and followed prospectively.
  
  
  RESULTS
  After 1 year, 995 patients (11.5%) died. Both the mean arterial pressure and systolic blood pressure were found to be inversely associated with mortality at univariate and multivariate analyses. An inverse univariate relation was observed between PP and all-cause mortality. An excess mortality risk in the lowest PP group (odds ratio 1.40, 95% confidence interval 1.09-1.79 vs the highest PP group) was confirmed in a multivariate analysis which took into account the effect of several other variables, including mean arterial pressure. Similar findings were obtained for cardiovascular mortality. When we replaced systolic blood pressure with mean arterial pressure in the model, PP did not retain its independent prognostic role, possibly because of the high co-linearity between these two variables (r = 0.87).
  
  
  CONCLUSIONS
  For any given level of mean arterial pressure, a low PP is an independent predictor of all-cause and cardiovascular death in patients with heart failure. The association may be partly related to the strong influence of low systolic blood pressure on mortality. Different pathophysiological mechanisms may underlie the opposite prognostic significance of PP in hypertension and heart failure.
authors.affiliation: Department of Clinical and Experimental Medicine, University of Perugia, Perugia, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Schillaci
authors.forename: Silvia
authors.initials: S
authors.lastname: Di Luzio
authors.forename: Mario
authors.initials: M
authors.lastname: Coluccini
authors.forename: Lucio
authors.initials: L
authors.lastname: Gonzini
authors.forename: Maurizio
authors.initials: M
authors.lastname: Porcu
authors.forename: Francesco
authors.initials: F
authors.lastname: Pozzar
authors.forename: Aldo P
authors.initials: AP
authors.lastname: Maggioni
mesh_terms: D000328:Adult; D000368:Aged; D001794:Blood Pressure / Q000502:physiology*; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000401:mortality* / Q000503:physiopathology*; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011674:Pulse; D012042:Registries; D013318:Stroke Volume / Q000502:physiology