title: Low systolic blood pressure at admission predicts long-term mortality in heart failure with preserved ejection fraction.
abstract: BACKGROUND
  Systolic blood pressure (SBP) at hospital admission predicts in-hospital and postdischarge mortality in patients with left ventricular systolic dysfunction. The relationship between admission SBP and mortality in heart failure with preserved (≥50%) ejection fraction (HFPEF) is still unclear.
  
  
  RESULTS
  We aimed to investigate the relationship between admission SBP and 5-year outcome in 368 consecutive patients hospitalized for new-onset HFPEF. Five-year all-cause mortality rates according to admission SBP categories (<120, 120-139, 140-159, 160-179, and ≥180 mm Hg) were 75 ± 7%, 53 ± 6%, 52 ± 7%, 55 ± 4%, and 60 ± 7%, respectively (P = .029). Survival analysis showed an inverse relation between admission SBP and mortality with increased risk of death for SBP <120 mm Hg. SBP <120 mm Hg independently predicted 5-year all-cause mortality (adjusted hazard ratio [HR] 1.69, 95% confidence interval [CI] 1.08-2.63) and cardiovascular mortality (adjusted HR 1.89, 95% CI 1.21-2.97). In patients discharged alive, after adjustment for medical treatment at discharge, admission SBP <120 mm Hg remained predictive of all-cause mortality (adjusted HR 1.52, 95% CI 1.04-2.43) and cardiovascular mortality (adjusted HR 1.69, 95% CI 1.06-2.73). There was no interaction between any of the therapeutic classes and outcome prediction of SBP.
  
  
  CONCLUSIONS
  In HFPEF, low SBP (<120 mm Hg) at the time of hospital admission is associated with excess long-term mortality. Further studies are required to determine the mechanism of this association.
authors: Department of Medicine and Cardiology, Abbeville General Hospital, Abbeville, France.
authors: Otilia
authors: O
authors: Buiciuc
authors: Dan
authors: D
authors: Rusinaru
authors: Franck
authors: F
authors: Lévy
authors: Marcel
authors: M
authors: Peltier
authors: Michel
authors: M
authors: Slama
authors: Laurent
authors: L
authors: Leborgne
authors: Christophe
authors: C
authors: Tribouilloy
mesh_terms: D000368:Aged; D001794:Blood Pressure; D016001:Confidence Intervals; D003971:Diastole; D018450:Disease Progression; D005260:Female; D005602:France; D054143:Heart Failure, Systolic / Q000401:mortality* / Q000473:pathology; D017052:Hospital Mortality; D006801:Humans; D007022:Hypotension; D015994:Incidence; D008297:Male; D011379:Prognosis; D016016:Proportional Hazards Models; D018570:Risk Assessment; D013318:Stroke Volume; D016019:Survival Analysis; D013599:Systole; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left