title: Systemic BP and heart rate as prognostic indicators in pulmonary arterial hypertension.
abstract: BACKGROUND
  Heart rate (HR) and systolic BP (SBP) are significant multivariate predictors of survival in patients with pulmonary arterial hypertension (PAH) as part of a 19-element formula. To what extent HR and BP alone predict survival and future hospitalization in patients with PAH is unknown.
  
  
  METHODS
  We analyzed data from the Registry to Evaluate Early and Long-term PAH Disease Management (REVEAL Registry), a prospective, observational study of patients with PAH. Patients were analyzed by quintile (Q) according to values of HR, SBP, and SBP/HR. Kaplan-Meier curves were calculated by Q for survival and freedom from hospitalization.
  
  
  RESULTS
  For patients in the worst Q, 1-year survival after enrollment was 85% ± 2% for SBP, 86% ± 2% for HR, and 84% ± 2% for SBP/HR vs 91% ± 1% for the middle three Qs (P &lt; .001). Hospitalization occurred more frequently than mortality but with a similar pattern among Qs. One-year survival after first follow-up of patients in the worst Q for change (Δ) in SBP since enrollment was 85% ± 2% (P = .004), 86% ± 2% for ΔHR (P = .12), and 84% ± 2% for ΔSBP/HR (P = .024) vs the middle three Qs (ΔSBP: 91% ± 1%; ΔHR: 90% ± 1%; ΔSBP/HR: 90% ± 1%).
  
  
  CONCLUSIONS
  Changes in vital signs from enrollment to first follow-up were less predictive of mortality than the values of vital-sign parameters at either enrollment or first follow-up. HR, SBP, and SBP/HR at enrollment identified high-risk groups with survival differences of 5% to 7% and freedom from hospitalization differences of 9% to 11% vs lower-risk groups. SBP/HR defines the highest-risk group, including most of the high-risk patients defined by HR and SBP separately.
  
  
  BACKGROUND
  ClinicalTrials.gov; No.: NCT00370214; URL: www.clinicaltrials.gov.
authors.affiliation: VA Greater Los Angeles Healthcare System and David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA. Electronic address: mbersohn@ucla.edu.
authors.forename: Malcolm M
authors.initials: MM
authors.lastname: Bersohn
authors.affiliation: ICON Late Phase & Outcomes Research, San Francisco, CA.
authors.forename: Michelle P
authors.initials: MP
authors.lastname: Turner
authors.affiliation: University of California, Los Angeles, Los Angeles, CA.
authors.forename: Glenna L
authors.initials: GL
authors.lastname: Traiger
authors.affiliation: Baylor College of Medicine, Houston, TX.
authors.forename: Adaani E
authors.initials: AE
authors.lastname: Frost
authors.affiliation: VA Greater Los Angeles Healthcare System and David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA.
authors.forename: Shelley
authors.initials: S
authors.lastname: Shapiro
mesh_terms: D001794:Blood Pressure / Q000502:physiology*; D019468:Disease Management; D065627:Familial Primary Pulmonary Hypertension; D005260:Female; D005500:Follow-Up Studies; D006339:Heart Rate / Q000502:physiology*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D006976:Hypertension, Pulmonary / Q000401:mortality / Q000503:physiopathology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D015996:Survival Rate / Q000639:trends; D014481:United States / Q000453:epidemiology