title: Prognostic value of long-term blood pressure changes in patients with chronic heart failure.
abstract: Chronic heart failure (CHF) is the final stage of many heart diseases. To improve outcomes, important risk factors for adverse clinical events in the CHF population need to be identified. The aim of the present study was to delineate the influence of long-term blood pressure (BP) changes on prognosis and mortality in a real-world cohort of CHF patients.
  
  
  
  This is a retrospective longitudinal analysis. Repeated office BP measurements were scheduled during follow-up visits every 3-6 months. The primary endpoint was time to death or heart transplantation (HTx). A Cox regression with time-dependent strata was used to analyse the effect of systolic BP (SBP) values and its change during follow-up on the primary endpoint. A total of 927 patients presented with a median survival of 7.7 [95% confidence interval (CI) 6.6-9.8] years. During follow-up, 220 patients died and 70 patients underwent HTx. The BP stratum with the most stable values showed the best survival. Blood pressure changes with an increase or decrease greater than ±10 mmHg per year led to a significantly worse outcome [hazard ratio (HR) 1.8 and 2.0, respectively]. The stratum with the lowest SBP levels (<90 mmHg) had the highest mortality. Multiple regression analysis showed a HR factor of 17 (95% CI 9.7-29) in comparison with the stratum with SBP ≥130 mmHg.
  
  
  
  Low SBP (<90 mmHg) and pronounced long-term changes in SBP were associated with poor survival in patients with CHF. Additional prospective studies are warranted to further specify optimal BP targets in patients with CHF.
authors.affiliation: University Heart Centre, Cardiology, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland.
authors.forename: Florian A
authors.initials: FA
authors.lastname: Schmid
authors.affiliation: University Heart Centre, Cardiology, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland.
authors.forename: Oliver
authors.initials: O
authors.lastname: Schlager
authors.affiliation: University Heart Centre, Cardiology, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland.
authors.forename: Philipp
authors.initials: P
authors.lastname: Keller
authors.affiliation: Department of Biostatistics, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland.
authors.forename: Burkhardt
authors.initials: B
authors.lastname: Seifert
authors.affiliation: Department of Biostatistics, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland.
authors.forename: Ruizhu
authors.initials: R
authors.lastname: Huang
authors.affiliation: University Heart Centre, Cardiology, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland.
authors.forename: Georg M
authors.initials: GM
authors.lastname: Fröhlich
authors.affiliation: University Heart Centre, Cardiology, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland.
authors.forename: Thomas F
authors.initials: TF
authors.lastname: Lüscher
authors.affiliation: University Heart Centre, Cardiology, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland.
authors.forename: Frank
authors.initials: F
authors.lastname: Ruschitzka
authors.affiliation: University Heart Centre, Cardiology, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland.
authors.forename: Frank
authors.initials: F
authors.lastname: Enseleit
mesh_terms: D000368:Aged; D001794:Blood Pressure / Q000502:physiology*; D001795:Blood Pressure Determination; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000401:mortality / Q000503:physiopathology* / Q000601:surgery; D016027:Heart Transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D013557:Switzerland / Q000453:epidemiology; D013599:Systole; D013997:Time Factors
keywords: Blood pressure changes; Chronic heart failure; Cohort study; Long-term follow-up; Prognosis