title: Association of blood pressure at hospital discharge with mortality in patients diagnosed with heart failure.
abstract: BACKGROUND
  Higher blood pressure in acute heart failure has been associated with improved survival; however, the relationship between blood pressure and survival in stabilized patients at hospital discharge has not been established.
  
  
  RESULTS
  In 7448 patients with heart failure (75.2+/-11.5 years; 49.9% men) discharged from the hospital in Ontario, Canada, we examined the association of systolic blood pressure (SBP) and diastolic blood pressure with long-term survival. Parametric survival analysis was performed, and survival time ratios were determined according to discharge blood pressure group. A total of 25 427 person-years of follow-up were examined. In those with left ventricular ejection fraction < or =40%, median survival was decreased by 17% (survival time ratio, 0.83; 95% CI, 0.71 to 0.98; P=0.029) when discharge SBP was 100 to 119 mm Hg and decreased by 23% (survival time ratio, 0.77; 95% CI, 0.62 to 0.97; P=0.024) when discharge SBP was <100 mm Hg, compared with those in the reference range of 120 to 139 mm Hg. Survival time ratios were 0.75 (95% CI, 0.60 to 0.92; P=0.007) and 0.75 (95% CI, 0.53 to 1.07; P=0.12) when discharge SBPs were 140 to 159 and > or =160 mm Hg, respectively. In those with left ventricular ejection fraction >40%, survival time ratios were 0.69 (95% CI, 0.51 to 0.93), 0.83 (95% CI, 0.71 to 0.99), 0.95 (95% CI, 0.80 to 1.14), and 0.76 (95% CI, 0.61 to 0.95) for discharge SBPs <100, 100 to 119, 140 to 159, and > or =160 mm Hg, respectively.
  
  
  CONCLUSIONS
  In this long-term population-based study of patients with heart failure, the association of discharge SBP with mortality followed a U-shaped distribution. Survival was shortened in those with reduced or increased values of discharge SBP.
authors.affiliation: Institute for Clinical Evaluative Sciences, Ontario, Canada. dlee@ices.on.ca
authors.forename: Douglas S
authors.initials: DS
authors.lastname: Lee
authors.forename: Nina
authors.initials: N
authors.lastname: Ghosh
authors.forename: John S
authors.initials: JS
authors.lastname: Floras
authors.forename: Gary E
authors.initials: GE
authors.lastname: Newton
authors.forename: Peter C
authors.initials: PC
authors.lastname: Austin
authors.forename: Xuesong
authors.initials: X
authors.lastname: Wang
authors.forename: Peter P
authors.initials: PP
authors.lastname: Liu
authors.forename: Thérèse A
authors.initials: TA
authors.lastname: Stukel
authors.forename: Jack V
authors.initials: JV
authors.lastname: Tu
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000401:mortality* / Q000503:physiopathology* / Q000628:therapy; D006801:Humans; D053208:Kaplan-Meier Estimate; D008017:Life Expectancy; D008297:Male; D008875:Middle Aged; D009864:Ontario / Q000453:epidemiology; D010351:Patient Discharge / Q000706:statistics & numerical data*; D016016:Proportional Hazards Models; D012042:Registries; D013318:Stroke Volume; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left