title: The prognostic importance of a history of hypertension in patients with symptomatic heart failure is substantially worsened by a short mitral inflow deceleration time.
abstract: BACKGROUND
  Hypertension is a common comorbidity in patients with heart failure and may contribute to development and course of disease, but the importance of a history of hypertension in patients with prevalent heart failure remains uncertain.
  
  
  METHODS
  3078 consecutively hospitalized heart failure patients (NYHA classes II-IV) were screened for the EchoCardiography and Heart Outcome Study (ECHOS). The left ventricular ejection fraction (LVEF) was estimated by 2 dimensional transthoracic echocardiography in all patients and a subgroup of 878 patients had additional data on pulsed wave Doppler assessment of transmitral flow available. A restrictive filling (RF) was defined as a mitral inflow deceleration time ≤140 ms. Patients were followed for a median of 6.8 (Inter Quartile Range 6.6-7.0) years and multivariable Cox regression models were used to assess the risk of all-cause mortality associated with hypertension.
  
  
  RESULTS
  The study population had a mean age of 73 ± 11 years. 39% were female, 27% had a history of hypertension and 48% had a RF. Over the study period, 64% of the population died. Hypertension was not associated with increased risk of mortality, hazard ratio (HR) 0.95 (0.85-1.05). LVEF did not modify this relationship (p for interaction = 0.7), but RF pattern substantially influenced the outcomes associated with hypertension (p for interaction < 0.001); HR 0.75 (0.57-0.99) and 1.41 (1.08-1.84) in patients without and with RF, respectively.
  
  
  CONCLUSIONS
  In patients with symptomatic heart failure, a history of hypertension is associated with a substantially increased relative risk of mortality among patients with a restrictive transmitral filling pattern.
authors.affiliation: Department of Cardiology, Gentofte Hospital, Hellerup, Denmark. ca@heart.dk
authors.forename: Charlotte
authors.initials: C
authors.lastname: Andersson
authors.forename: Gunnar H
authors.initials: GH
authors.lastname: Gislason
authors.forename: Peter
authors.initials: P
authors.lastname: Weeke
authors.forename: Jesper
authors.initials: J
authors.lastname: Kjaergaard
authors.forename: Christian
authors.initials: C
authors.lastname: Hassager
authors.forename: Dilek
authors.initials: D
authors.lastname: Akkan
authors.forename: Jacob E
authors.initials: JE
authors.lastname: Møller
authors.forename: Lars
authors.initials: L
authors.lastname: Køber
authors.forename: Christian
authors.initials: C
authors.lastname: Torp-Pedersen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002317:Cardiovascular Agents / Q000627:therapeutic use; D016009:Chi-Square Distribution; D015897:Comorbidity; D004311:Double-Blind Method; D018619:Echocardiography, Doppler, Pulsed; D005260:Female; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000401:mortality / Q000503:physiopathology*; D006801:Humans; D006973:Hypertension / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology*; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000503:physiopathology*; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D018570:Risk Assessment; D012307:Risk Factors; D012537:Scandinavian and Nordic Countries / Q000453:epidemiology; D013318:Stroke Volume; D013764:Tetrahydronaphthalenes / Q000627:therapeutic use; D013997:Time Factors; D016277:Ventricular Function, Left
chemical_list: D002317:Cardiovascular Agents; D013764:Tetrahydronaphthalenes; C457559:nolomirole