title: Impact of antecedent hypertension on outcomes in patients hospitalized with severe forms of acute heart failure.
abstract: OBJECTIVE
  Even though several studies described a positive influence of elevated initial blood pressure on the outcome in acute heart failure (AHF), data specifically addressed to a population with severe AHF associated with antecedent hypertension, regardless of admission blood pressure values, are missing.
  
  
  RESULTS
  From the 4153 consecutive patients enrolled in the Czech AHF registry we selected 1343 patients who suffered from pulmonary oedema or cardiogenic shock and compared them according to the presence of antecedent hypertension. Demographic, clinical, laboratory, treatment profiles and mortality rates were assessed and predictors of short- and long-term outcome were identified. Patients with antecedent hypertension (n = 1053, 78%) were older (P < 0.001), more often women (P = 0.001), having more co-morbidities and a worse laboratory profile. A trend for worse survival of hypertensive patients was observed when compared to a non-hypertensive cohort (1-, 2-, 3-year survival 70.0, 61.5, 55.5% vs. 72.6, 68.2, 64.0%, P = 0.062). Age and creatinine levels were independently associated with mortality during the whole follow-up period (P < 0.001). Low left ventricular ejection fraction, need of mechanical ventilation, inotropic and vasopressor support, were adversely related to in-hospital mortality (P < 0.001). On the other hand, presence of initial tachycardia improved short-term outcome (P = 0.007). Long-term survival was worsened by initial atrial fibrillation (P = 0.036) and anaemia (P < 0.001) while the presence of de-novo AHF improved it (P = 0.009).
  
  
  CONCLUSIONS
  Long-term antecedent hypertension is not significantly correlated with mortality after an episode of severe AHF, but probably still participates in vascular and end-organ damage. Survival of these patients is determined by other associated co-morbidities.
authors.affiliation: First Department of Internal Medicine--Cardiology, University Hospital Brno and Faculty of Medicine of Masaryk University, Brno.
authors.forename: Marián
authors.initials: M
authors.lastname: Felsöci
authors.forename: Jirí
authors.initials: J
authors.lastname: Parenica
authors.forename: Jindrich
authors.initials: J
authors.lastname: Spinar
authors.forename: Jirí
authors.initials: J
authors.lastname: Vítovec
authors.forename: Petr
authors.initials: P
authors.lastname: Widimský
authors.forename: Ales
authors.initials: A
authors.lastname: Linhart
authors.forename: Jan
authors.initials: J
authors.lastname: Václavík
authors.forename: Filip
authors.initials: F
authors.lastname: Málek
authors.forename: Miroslav
authors.initials: M
authors.lastname: Bambuch
authors.forename: Roman
authors.initials: R
authors.lastname: Miklík
authors.forename: Lenka
authors.initials: L
authors.lastname: Spinarová
authors.forename: Jan
authors.initials: J
authors.lastname: Bĕlohlávek
authors.forename: Cestmír
authors.initials: C
authors.lastname: Cíhalík
authors.forename: Jirí
authors.initials: J
authors.lastname: Jarkovský
mesh_terms: D000208:Acute Disease; D000368:Aged; D001794:Blood Pressure / Q000502:physiology*; D018153:Czech Republic / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000150:complications / Q000453:epidemiology* / Q000503:physiopathology; D017052:Hospital Mortality / Q000639:trends; D006760:Hospitalization; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000453:epidemiology* / Q000503:physiopathology; D015994:Incidence; D008297:Male; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors