title: Is the blood pressure paradox observed in all heart failure patients?
abstract: BACKGROUND
  Heart failure (HF) patients with higher systolic blood pressure (SBP) survive longer. Diabetes mellitus (DM) is a frequent comorbidity in HF. We evaluated the prognostic significance of low SBP according to DM in acute HF.
  
  
  METHODS
  We prospectively recruited 589 patients admitted with acute HF. DM was defined according to the 2011 American Diabetes Association recommendations. Patients were followed for 6 months and HF-death was the endpoint. A multivariate Cox-regression model was used to assess the prognostic impact of SBP. A stratified analysis according to DM was performed.
  
  
  RESULTS
  Median patients' age was 79 years and DM was present in 50.8%. Ischemic aetiology HF and hypertension history were more common in diabetics. Diabetic patients had worse renal function and lower total cholesterol and were more often discharged with antiplatelet therapy and statin. During followup, 89 patients died due to HF. The multivariate-adjusted HR for the 6-month HF death in non-diabetic patients with an admission SBP < 115 mmHg (1st quartile) was 2.94 (95% CI: 1.49-5.79), while lower admission SBP was not associated with HF mortality in diabetics.
  
  
  CONCLUSIONS
  The blood pressure paradox in HF is only observed in non-diabetic HF patients. Diabetic patients seem to be a particular subgroup of HF patients.
authors.affiliation: Serviço de Medicina Interna, Centro Hospitalar de São João, Alameda Professor Hernâni Monteiro, 4202-451 Porto, Portugal.
authors.forename: F M
authors.initials: FM
authors.lastname: Cunha
authors.affiliation: Serviço de Medicina Interna, Centro Hospitalar de São João, Alameda Professor Hernâni Monteiro, 4202-451 Porto, Portugal ; Unidade I&D Cardiovascular do Porto, Faculdade de Medicina da Universidade do Porto, 4202-451 Porto, Portugal.
authors.forename: P
authors.initials: P
authors.lastname: Lourenço
authors.affiliation: Serviço de Medicina Interna, Centro Hospitalar de São João, Alameda Professor Hernâni Monteiro, 4202-451 Porto, Portugal.
authors.forename: M
authors.initials: M
authors.lastname: Couto
authors.affiliation: Serviço de Medicina Interna, Centro Hospitalar de São João, Alameda Professor Hernâni Monteiro, 4202-451 Porto, Portugal.
authors.forename: P
authors.initials: P
authors.lastname: Tavares
authors.affiliation: Serviço de Medicina Interna, Centro Hospitalar de São João, Alameda Professor Hernâni Monteiro, 4202-451 Porto, Portugal ; Unidade I&D Cardiovascular do Porto, Faculdade de Medicina da Universidade do Porto, 4202-451 Porto, Portugal.
authors.forename: S
authors.initials: S
authors.lastname: Silva
authors.affiliation: Serviço de Patologia Clínica, Centro Hospitalar São João, Departamento de Bioquímica da Faculdade de Medicina da Universidade do Porto, 4202-451 Porto, Portugal.
authors.forename: J T
authors.initials: JT
authors.lastname: Guimarães
authors.affiliation: Serviço de Medicina Interna, Centro Hospitalar de São João, Alameda Professor Hernâni Monteiro, 4202-451 Porto, Portugal ; Unidade I&D Cardiovascular do Porto, Faculdade de Medicina da Universidade do Porto, 4202-451 Porto, Portugal.
authors.forename: P
authors.initials: P
authors.lastname: Bettencourt
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure; D048909:Diabetes Complications / Q000473:pathology*; D003920:Diabetes Mellitus / Q000473:pathology; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000473:pathology*; D006801:Humans; D008297:Male; D011379:Prognosis; D016896:Treatment Outcome