title: Low pulse pressure is an independent predictor of mortality and morbidity in non ischaemic, but not in ischaemic advanced heart failure patients.
abstract: In patients with atherosclerotic disease, a high pulse pressure is an important predictor of cardiovascular events. However, in patients with chronic heart failure (CHF) a low pulse pressure is related to worse outcome, although no distinction was made between ischaemic and non ischaemic heart failure. We therefore aimed to compare the prognostic value of pulse pressure (PP) between those with ischaemic and non ischaemic advanced heart failure.
  
  
  RESULTS
  Pulse pressure was analysed for its effect on mortality, adjusting for other modifiers of risk, using Cox proportional hazards regression analysis of data collected from 1901 patients with NYHA class III or IV heart failure (mean age 65 years, mean ejection fraction 26%). In ischaemic heart failure (n=1118), low mean arterial pressure (MAP) was an independent predictor of overall mortality (Hazard Ratio (HR) 0.88 per 10 mm Hg; p=0.04), while pulse pressure was not. In contrast, in non ischaemic heart failure (n=783), a low pulse pressure was an independent predictor of overall mortality (HR 0.84 per 10 mm Hg; p=0.036), while mean arterial pressure was not. In addition, higher NYHA class and lower pulse pressure (HR 0.87 per 10 mm Hg; p=0.002) were the only independent predictors for first heart failure hospitalisation in both ischaemic and non ischaemic patients.
  
  
  CONCLUSIONS
  Low pulse pressure is a readily obtainable risk marker of death in advanced non ischaemic heart failure. Mean arterial pressure remains an important component of blood pressure in predicting mortality, especially in those with heart failure of an ischaemic aetiology. It is postulated that pulse pressure may reflect a deleterious haemodynamic state, in non-atherosclerotic heart failure patients.
authors.affiliation: Clinical Research Initiative in Heart Failure, University of Glasgow, G12 8QQ, Glasgow, Scotland, G11 6NT, UK. colinjamespetrie@yahoo.co.uk
authors.forename: Colin J
authors.initials: CJ
authors.lastname: Petrie
authors.forename: Adriaan A
authors.initials: AA
authors.lastname: Voors
authors.forename: Dirk J
authors.initials: DJ
authors.lastname: van Veldhuisen
mesh_terms: D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure; D003846:Deoxyepinephrine / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000627:therapeutic use; D018450:Disease Progression; D018491:Dopamine Agonists / Q000008:administration & dosage / Q000627:therapeutic use; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000188:drug therapy / Q000401:mortality* / Q000503:physiopathology*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000150:complications*; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D055815:Young Adult
chemical_list: D018491:Dopamine Agonists; C023487:ibopamine; D003846:Deoxyepinephrine