title: Change in blood pressure during hospitalisation for acute heart failure predicts mortality.
abstract: OBJECTIVE
  In patients with acute heart failure (HF) there is an inverse relation between blood pressure (BP) and mortality but the prognostic impact of the change in BP between admission and discharge is not known. The primary objective was to study the impact of the change in BP during a hospitalisation for acute HF on prognosis.
  
  
  METHODS
  We studied 208 consecutive patients admitted with acute heart failure and discharged alive, age 77 ± 10 years, 49.5% women.
  
  
  RESULTS
  BP at admission was 145 ± 35/85 ± 9 mmHg compared to 132 ± 24/76 ± 13 mmHg at discharge. The average number of BP lowering medications at admission and discharge was 2.1 ± 1.2 and 2.8 ± 1.0 respectively. The average number of BP lowering medications with dose increased at discharge compared to admission was 0.3 ± 0.5. Univariate predictors of all-cause mortality at 12 and/or 40 months were admission SBP and DBP, discharge DBP, decrease in SBP and DBP during hospitalisation, age, eGFR, number of added BP-lowering medications during the hospitalisation and left ventricular ejection fraction (LVEF). Multivariate predictors at 12 and/or 40 month were admission DBP, decrease in DBP, age, eGFR, LVEF and number of new BP-lowering medications added during the hospitalisation.
  
  
  CONCLUSIONS
  A decrease in BP during hospitalisation for acute heart failure was a predictor of all cause mortality. A higher admission BP and the tolerability of added medications probably played a role, and our findings need confirmation in larger studies.
authors.affiliation: Department of Emergency Medicine, Karolinska University Hospital-Solna, Stockholm, Sweden. per.svensson@karolinska.se
authors.forename: Per
authors.initials: P
authors.lastname: Svensson
authors.forename: Helena
authors.initials: H
authors.lastname: Sundberg
authors.forename: Lars H
authors.initials: LH
authors.lastname: Lund
authors.forename: Jan
authors.initials: J
authors.lastname: Östergren
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure / Q000187:drug effects*; D016001:Confidence Intervals; D005260:Female; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000401:mortality*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000401:mortality; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends; D015999:Multivariate Analysis; D011379:Prognosis; D016016:Proportional Hazards Models; D012042:Registries; D012189:Retrospective Studies; D012306:Risk; D012307:Risk Factors; D013223:Statistics as Topic; D013318:Stroke Volume; D016019:Survival Analysis; D013548:Sweden; D013997:Time Factors; D014463:Ultrasonography; D016277:Ventricular Function, Left