title: Does previous hypertension affect outcome in acute heart failure?
abstract: BACKGROUND
  The effect of previous long-term hypertension on mortality in acute heart failure (HF), regardless of blood pressure values, has not been well studied.
  
  
  METHODS
  Acute Heart Failure Database (AHEAD) - Czech HF registry enrolled 4153 consecutive patients with acute HF. We excluded severe forms (cardiogenic shock, pulmonary oedema, right HF) and analysed 2421 patients with known presence or absence of previous hypertension. Demographic, clinical and laboratory profile, treatment and mortality rates were assessed and predictors of outcome were identified.
  
  
  RESULTS
  Patients with previous hypertension (71.5%) were older, more of female gender, with worse pre-hospitalisation NYHA class, increased incidence of co-morbidities and higher left ventricular ejection fraction (LVEF). Although in-hospital mortality was similar in both cohorts (2.6%), survival at 1, 2 and 3-year was worse in the hypertensive group (75.6%, 65.9% and 58.7% vs. 80.7%, 74.2% and 69.8%; P<0.001). Nevertheless, hypertension was not associated with mortality in multivariate analysis and stronger predictors of outcome were identified (P<0.05): new-onset acute HF [hazard ratio (HR) 0.62] and increased body mass index (HR 0.68) proved to have a protective role. Advanced age (HR 1.86), diabetes (HR 1.45), lower LVEF (HR 1.28) and admission blood pressure (HR 1.54), elevated serum creatinine (HR 1.63), hyponatremia (HR 1.77) and anaemia (HR 1.40) were associated with worse survival.
  
  
  CONCLUSIONS
  Antecedent hypertension is frequent in patients with acute HF and contributes to organ and vascular impairment. However its presence has no independent influence on short- and medium-term mortality, which is influenced by other related co-morbidities.
authors.affiliation: 1st Department of Internal Medicine - Cardiology, University Hospital Brno, Brno, Czech Republic.
authors.forename: Marián
authors.initials: M
authors.lastname: Felšöci
authors.forename: Jiří
authors.initials: J
authors.lastname: Pařenica
authors.forename: Jindřich
authors.initials: J
authors.lastname: Spinar
authors.forename: Jiří
authors.initials: J
authors.lastname: Vítovec
authors.forename: Petr
authors.initials: P
authors.lastname: Widimský
authors.forename: Aleš
authors.initials: A
authors.lastname: Linhart
authors.forename: Marián
authors.initials: M
authors.lastname: Fedorco
authors.forename: Filip
authors.initials: F
authors.lastname: Málek
authors.forename: Cestmír
authors.initials: C
authors.lastname: Cíhalík
authors.forename: Roman
authors.initials: R
authors.lastname: Miklík
authors.forename: Jiří
authors.initials: J
authors.lastname: Jarkovský
mesh_terms: D000208:Acute Disease; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000453:epidemiology; D001794:Blood Pressure; D018153:Czech Republic / Q000453:epidemiology; D003920:Diabetes Mellitus / Q000401:mortality; D005260:Female; D006333:Heart Failure / Q000401:mortality*; D006801:Humans; D006973:Hypertension / Q000401:mortality*; D007010:Hyponatremia / Q000401:mortality; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012042:Registries / Q000706:statistics & numerical data*; D012307:Risk Factors; D017678:Sex Distribution; D018487:Ventricular Dysfunction, Left / Q000401:mortality