title: Early drop in systolic blood pressure and worsening renal function in acute heart failure: renal results of Pre-RELAX-AHF.
abstract: OBJECTIVE
  We aimed to determine the relation between baseline systolic blood pressure (SBP), change in SBP, and worsening renal function (WRF) in acute heart failure (AHF) patients enrolled in the Pre-RELAX-AHF trial.
  
  
  RESULTS
  The Pre-RELAX-AHF study enrolled 234 patients within 16 h of admission (median 7 h) for AHF and randomized them to relaxin given intravenous (i.v.) for 48 h or placebo. Blood pressure was measured at baseline, at 3, 6, 9, 12, 24, 36, and 48 h and at 3, 4, and 5 days after enrolment. Worsening renal function was defined as a serum creatinine increase of ≥0.3 mg/dL by Day 5. Worsening renal function was found in 68 of the 225 evaluable patients (30%). Patients with WRF were older (73.5 ± 9.4 vs. 69.1 ± 10.6 years; P= 0.003), had a higher baseline SBP (147.3 ± 19.9 vs. 140.8 ± 16.7 mmHg; P= 0.01), and had a greater early drop in SBP (37.9 ± 16.0 vs. 31.4 ± 12.2 mmHg; P= 0.004). In a multivariable model, higher age, higher baseline creatinine, and a greater early drop in SBP, but not baseline SBP, remained independent predictors of WRF. Furthermore, WRF was associated with a higher Day 60 (P= 0.01), and Day 180 (P= 0.003) mortality.
  
  
  CONCLUSIONS
  Worsening renal function in hospitalized AHF patients is related to a poor clinical outcome and is predicted by a greater early drop in SBP. Trial registration clinicaltrials.gov identifier NCT00520806.
authors.affiliation: Department of Cardiology, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands. a.a.voors@thorax.umcg.nl
authors.forename: Adriaan A
authors.initials: AA
authors.lastname: Voors
authors.forename: Beth A
authors.initials: BA
authors.lastname: Davison
authors.forename: G Michael
authors.initials: GM
authors.lastname: Felker
authors.forename: Piotr
authors.initials: P
authors.lastname: Ponikowski
authors.forename: Elaine
authors.initials: E
authors.lastname: Unemori
authors.forename: Gadi
authors.initials: G
authors.lastname: Cotter
authors.forename: John R
authors.initials: JR
authors.lastname: Teerlink
authors.forename: Barry H
authors.initials: BH
authors.lastname: Greenberg
authors.forename: Gerasimos
authors.initials: G
authors.lastname: Filippatos
authors.forename: Sam L
authors.initials: SL
authors.lastname: Teichman
authors.forename: Marco
authors.initials: M
authors.lastname: Metra
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology / Q000401:mortality / Q000503:physiopathology*; D000368:Aged; D000959:Antihypertensive Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001794:Blood Pressure; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D010865:Pilot Projects; D012065:Relaxin / Q000008:administration & dosage / Q000627:therapeutic use*; D013599:Systole; D016896:Treatment Outcome
chemical_list: D000959:Antihypertensive Agents; D012065:Relaxin