title: Impact of baseline systolic blood pressure on long-term outcomes in patients with advanced chronic systolic heart failure (insights from the BEST trial).
abstract: The impact of baseline systolic blood pressure (SBP) on outcomes in patients with advanced chronic systolic heart failure (HF) has not been studied using a propensity-matched design. Of the 2,706 participants in the Beta-Blocker Evaluation of Survival Trial (BEST) with chronic HF, New York Heart Association class III to IV symptoms and left ventricular ejection fraction < or =35%, 1,751 had SBP < or =120 mm Hg (median 108, range 70 to 120) and 955 had SBP >120 mm Hg (median 134, range 121 to 192). Propensity scores for SBP >120 mm Hg, calculated for each patient, were used to assemble a matched cohort of 545 pairs of patients with SBPs < or =120 and >120 mm Hg who were balanced in 65 baseline characteristics. Matched Cox regression models were used to estimate associations between SBP < or =120 mm Hg and outcomes over 4 years of follow-up. Matched participants had a mean age +/- SD of 62 +/- 12 years, 24% were women, and 24% were African-American. HF hospitalization occurred in 38% and 32% of patients with SBPs < or =120 and >120 mm Hg, respectively (hazard ratio 1.33 SBP < or =120 was compared to >120 mm Hg, 95% confidence interval 1.04 to 1.69, p = 0.023). All-cause mortality occurred in 28% and 30% of matched patients with SBPs < or =120 and >120 mm Hg, respectively (hazard ratio 1.13 SBP < or =120 compared to >120 mm Hg, 95% confidence interval 0.86 to 1.49, p = 0.369). In conclusion, in patients with advanced chronic systolic HF, baseline SBP < or =120 mm Hg is associated with increased risk of HF hospitalization, but had no association with all-cause mortality.
authors.affiliation: University of Alabama at Birmingham, AL, USA.
authors.forename: Ravi V
authors.initials: RV
authors.lastname: Desai
authors.forename: Maciej
authors.initials: M
authors.lastname: Banach
authors.forename: Mustafa I
authors.initials: MI
authors.lastname: Ahmed
authors.forename: Marjan
authors.initials: M
authors.lastname: Mujib
authors.forename: Inmaculada
authors.initials: I
authors.lastname: Aban
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Love
authors.forename: Michel
authors.initials: M
authors.lastname: White
authors.forename: Gregg
authors.initials: G
authors.lastname: Fonarow
authors.forename: Prakash
authors.initials: P
authors.lastname: Deedwania
authors.forename: Wilbert S
authors.initials: WS
authors.lastname: Aronow
authors.forename: Ali
authors.initials: A
authors.lastname: Ahmed
mesh_terms: D000368:Aged; D001794:Blood Pressure; D005260:Female; D054143:Heart Failure, Systolic / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013599:Systole; D013997:Time Factors