title: Association of Arterial Pulse Pressure With Long-Term Clinical Outcomes in Patients With Heart Failure.
abstract: OBJECTIVE
  This study assessed the association between pulse pressure (PP) and adverse outcomes at 1 year in patients hospitalized for heart failure (HF).
  
  
  BACKGROUND
  PP has been shown to be predictive of the development of HF. The value and utility of PP assessment in patients with prevalent HF is less clear.
  
  
  METHODS
  We conducted a retrospective cohort study from clinical registry data linked to Medicare claims for 40,421 HF patients entered in the Get With the Guidelines-HF program. Cox proportional hazards models were used to estimate the association between discharge PP and all-cause mortality and the composite outcome of all-cause mortality/readmission by 1 year.
  
  
  RESULTS
  A nonlinear association between PP and mortality (expressed as hazard ratio [HR] per 10-mm Hg increase in PP) was observed in patients with HF and reduced (<0.40) ejection fraction (EF). Risk decreased as PP increased up to 50 mm Hg (adjusted HR: 0.946; 95% confidence interval [CI]: 0.900 to 0.995; p = 0.03). When PP was ≥50 mm Hg, risk increased as PP increased (adjusted HR: 1.091; 95% CI: 1.050 to 1.135; p < 0.001). In patients with HF and preserved EF (≥0.40), there was a significant association between PP and mortality with risk increasing as PP increased, although the magnitude of the risk was significantly impacted by systolic blood pressure (SBP). Qualitatively similar observations were obtained for the composite outcome and use of EF ≥0.50 to define HF with preserved EF.
  
  
  CONCLUSIONS
  The association between PP at hospital discharge and 1-year outcomes is a function of HF phenotype, SBP, and absolute PP.
authors.affiliation: Division of Cardiology, Department of Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico. Electronic address: wlaskey@salud.unm.edu.
authors.forename: Warren K
authors.initials: WK
authors.lastname: Laskey
authors.affiliation: Duke Clinical Research Institute, Duke University, Durham, North Carolina.
authors.forename: Jingjing
authors.initials: J
authors.lastname: Wu
authors.affiliation: Duke Clinical Research Institute, Duke University, Durham, North Carolina.
authors.forename: Phillip J
authors.initials: PJ
authors.lastname: Schulte
authors.affiliation: Duke Clinical Research Institute, Duke University, Durham, North Carolina.
authors.forename: Adrian F
authors.initials: AF
authors.lastname: Hernandez
authors.affiliation: Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Clyde W
authors.initials: CW
authors.lastname: Yancy
authors.affiliation: Division of Cardiology, Department of Medicine, Veterans' Affairs Palo Alto Health Care System, Palo Alto, California.
authors.forename: Paul A
authors.initials: PA
authors.lastname: Heidenreich
authors.affiliation: Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston, Massachusetts.
authors.forename: Deepak L
authors.initials: DL
authors.lastname: Bhatt
authors.affiliation: Division of Cardiology, Department of Medicine, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California.
authors.forename: Gregg C
authors.initials: GC
authors.lastname: Fonarow
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D055109:Ankle Brachial Index; D001794:Blood Pressure / Q000502:physiology*; D002423:Cause of Death; D015331:Cohort Studies; D005260:Female; D006333:Heart Failure / Q000401:mortality / Q000503:physiopathology* / Q000628:therapy; D006801:Humans; D008297:Male; D010351:Patient Discharge; D017410:Practice Guidelines as Topic; D011379:Prognosis; D012042:Registries; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology
keywords: heart failure; pulse pressure