title: Acute heart failure associated with high admission blood pressure--a distinct vascular disorder?
abstract: BACKGROUND
  Although blood pressure (BP) is elevated in patients with acute heart failure (AHF), first admission BP has not been meticulously recorded before treatment in previous studies.
  
  
  METHODS
  During three consecutive months, all AHF admissions (335 patients) to a city hospital which provides the sole inpatient medical service for approximately 500,000 people were registered. First BP was recorded before treatment at the first patient encounter in the ambulance or the emergency room.
  
  
  RESULTS
  Mean BP at admission was 164+/-38/88+/-22 mm Hg. Mean BP in the highest quartile was 212+/-22/115+/-13 mm Hg. Patients with higher baseline BP had higher ejection fraction (highest versus lowest quartile 48+/-13% vs. 33+/-14%, p<0.001), less atrial fibrillation (18% vs. 42%, p=0.001) as well as lower mean urea and higher mean haemoglobin. The apparently more favourable baseline characteristics in patients with higher admission BP did not translate into lower morbidity - the rate of worsening heart failure - was not related to admission BP. However, 6 month mortality was lower in patients with higher admission BP (4% vs. 19.3%, p=0.002).
  
  
  CONCLUSIONS
  Blood pressure is elevated substantially at the onset of AHF. The different characteristics and outcome of patients admitted with high-BP associated AHF suggest that this presentation may be a specific disorder related to a distinct yet unknown pathophysiological mechanism.
authors.affiliation: Duke University Medical Center and the Duke Clinical Research Institute, Durham NC, 27515, USA.
authors.forename: Olga
authors.initials: O
authors.lastname: Milo-Cotter
authors.forename: Kirkwood F
authors.initials: KF
authors.lastname: Adams
authors.forename: Christopher M
authors.initials: CM
authors.lastname: O'Connor
authors.forename: Nir
authors.initials: N
authors.lastname: Uriel
authors.forename: Edo
authors.initials: E
authors.lastname: Kaluski
authors.forename: G Michael
authors.initials: GM
authors.lastname: Felker
authors.forename: Beth
authors.initials: B
authors.lastname: Weatherley
authors.forename: Zvi
authors.initials: Z
authors.lastname: Vered
authors.forename: Gad
authors.initials: G
authors.lastname: Cotter
mesh_terms: D000208:Acute Disease; D000368:Aged; D001281:Atrial Fibrillation; D001795:Blood Pressure Determination / Q000706:statistics & numerical data*; D015897:Comorbidity; D005260:Female; D006333:Heart Failure / Q000503:physiopathology*; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000503:physiopathology*; D008297:Male; D010343:Patient Admission; D010351:Patient Discharge; D012720:Severity of Illness Index; D013318:Stroke Volume; D016896:Treatment Outcome