Association of blood pressure at hospital discharge with mortality in patients diagnosed with heart failure.
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.
Lee
Douglas S
DS
Institute for Clinical Evaluative Sciences, Ontario, Canada. dlee@ices.on.ca
Ghosh
Nina
N
Floras
John S
JS
Newton
Gary E
GE
Austin
Peter C
PC
Wang
Xuesong
X
Liu
Peter P
PP
Stukel
Thérèse A
TA
Tu
Jack V
JV
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