title: Differing prognostic value of pulse pressure in patients with heart failure with reduced or preserved ejection fraction: results from the MAGGIC individual patient meta-analysis.
abstract: OBJECTIVE
  Low pulse pressure is a marker of adverse outcome in patients with heart failure (HF) and reduced ejection fraction (HF-REF) but the prognostic value of pulse pressure in patients with HF and preserved ejection fraction (HF-PEF) is unknown. We examined the prognostic value of pulse pressure in patients with HF-PEF [ejection fraction (EF) ≥ 50%] and HF-REF.
  
  
  RESULTS
  Data from 22 HF studies were examined. Preserved left ventricular ejection fraction (LVEF) was defined as LVEF ≥ 50%. All-cause mortality at 3 years was evaluated in 27 046 patients: 22 038 with HF-REF (4980 deaths) and 5008 with HF-PEF (828 deaths). Pulse pressure was analysed in quintiles in a multivariable model adjusted for the previously reported Meta-Analysis Global Group in Chronic Heart Failure prognostic variables. Heart failure and reduced ejection fraction patients in the lowest pulse pressure quintile had the highest crude and adjusted mortality risk (adjusted hazard ratio 1.68, 95% confidence interval 1.53-1.84) compared with all other pulse pressure groups. For patients with HF-PEF, higher pulse pressure was associated with the highest crude mortality, a gradient that was eliminated after adjustment for other prognostic variables.
  
  
  CONCLUSIONS
  Lower pulse pressure (especially <53 mmHg) was an independent predictor of mortality in patients with HF-REF, particularly in those with an LVEF < 30% and systolic blood pressure <140 mmHg. Overall, this relationship between pulse pressure and outcome was not consistently observed among patients with HF-PEF.
authors.affiliation: BHF Cardiovascular Research Centre, University of Glasgow, 126 University Place, Glasgow G12 8TA, UK colettejackson@doctors.org.uk.
authors.forename: Colette E
authors.initials: CE
authors.lastname: Jackson
authors.affiliation: Division of Cardiology, Città della Salute e della Scienza Hospital, Department of Medical Sciences, University of Turin, Torino, Italy.
authors.forename: Davide
authors.initials: D
authors.lastname: Castagno
authors.affiliation: Associazione Nazionale Medici Cardiologi Ospedalieri Research Center, Florence, Italy.
authors.forename: Aldo P
authors.initials: AP
authors.lastname: Maggioni
authors.affiliation: Department of Cardiology, Rigshospitalet-Copenhagen University Hospital, Copenhagen, Denmark.
authors.forename: Lars
authors.initials: L
authors.lastname: Køber
authors.affiliation: University of Leicester and NIHR Biomedical Research Unit, Glenfield Hospital, Leicester, UK.
authors.forename: Iain B
authors.initials: IB
authors.lastname: Squire
authors.affiliation: National Heart and Lung Institute, Imperial College, London, UK Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden.
authors.forename: Karl
authors.initials: K
authors.lastname: Swedberg
authors.affiliation: Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden.
authors.forename: Bert
authors.initials: B
authors.lastname: Andersson
authors.affiliation: Department of Medicine, University of Otago, Christchurch, New Zealand National University Heart Centre, Singapore.
authors.forename: A Mark
authors.initials: AM
authors.lastname: Richards
authors.affiliation: Heart Failure Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.
authors.forename: Antoni
authors.initials: A
authors.lastname: Bayes-Genis
authors.affiliation: Department of Cardiology, University Hospital Amiens, Amiens, France INSERM U-1088, JulesVerne University of Picardie, Amiens, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Tribouilloy
authors.affiliation: Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Joanna
authors.initials: J
authors.lastname: Dobson
authors.affiliation: Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Cono A
authors.initials: CA
authors.lastname: Ariti
authors.affiliation: Department of Medicine and National Institute for Health Innovation, University of Auckland, Auckland, New Zealand.
authors.forename: Katrina K
authors.initials: KK
authors.lastname: Poppe
authors.affiliation: Department of Medicine and National Institute for Health Innovation, University of Auckland, Auckland, New Zealand.
authors.forename: Nikki
authors.initials: N
authors.lastname: Earle
authors.affiliation: Unitec Institute of Technology, Auckland, New Zealand.
authors.forename: Gillian
authors.initials: G
authors.lastname: Whalley
authors.affiliation: Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Stuart J
authors.initials: SJ
authors.lastname: Pocock
authors.affiliation: Department of Medicine and National Institute for Health Innovation, University of Auckland, Auckland, New Zealand.
authors.forename: Robert N
authors.initials: RN
authors.lastname: Doughty
authors.affiliation: BHF Cardiovascular Research Centre, University of Glasgow, 126 University Place, Glasgow G12 8TA, UK.
authors.forename: John J V
authors.initials: JJ
authors.lastname: McMurray
mesh_terms: D000208:Acute Disease; D002423:Cause of Death; D002908:Chronic Disease; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000401:mortality* / Q000503:physiopathology; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D064887:Observational Studies as Topic; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic; D013318:Stroke Volume / Q000502:physiology
keywords: Heart failure; Mortality; Preserved ejection fraction; Pulse pressure; Reduced ejection fraction