MedStar Authors catalog › Details for: Systolic Blood Pressure and Outcomes in Patients With Heart Failure With Reduced Ejection Fraction.
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Systolic Blood Pressure and Outcomes in Patients With Heart Failure With Reduced Ejection Fraction.

by Gill, Gauravpal S; Lam, Phillip H.
Citation: ; Journal of the American College of Cardiology. 73(24):3054-3063, 2019 06 25..Journal: Journal of the American College of Cardiology.Published: ; 2019; ISSN: 0735-1097.Full author list: Ahmed A; Allman RM; Aronow WS; Arundel C; Faselis C; Fonarow GC; Gill GS; Lam PH; Morgan CJ; Panjrath G; Patel S; Singh SN; White M.UI/PMID: 31221253.Subject(s): *Blood Pressure | *Heart Failure | *Stroke Volume | *Ventricular Dysfunction, Left | Aged | Blood Pressure Determination/sn [Statistics & Numerical Data] | Female | Heart Failure/di [Diagnosis] | Heart Failure/mo [Mortality] | Heart Failure/pp [Physiopathology] | Heart Failure/th [Therapy] | Hospitalization/sn [Statistics & Numerical Data] | Humans | Male | Medicare/sn [Statistics & Numerical Data] | Mortality | Registries | Risk Factors | United States/ep [Epidemiology] | Ventricular Dysfunction, Left/ep [Epidemiology] | Ventricular Dysfunction, Left/pp [Physiopathology]Institution(s): MedStar Heart & Vascular Institute | MedStar Washington Hospital CenterDepartment(s): Medicine/Internal MedicineActivity type: Journal Article.Medline article type(s): Journal Article | Research Support, N.I.H., Extramural | Research Support, Non-U.S. Gov'tOnline resources: Click here to access online Digital Object Identifier: https://dx.doi.org/10.1016/j.jacc.2019.04.022 (Click here) Abbreviated citation: ; J Am Coll Cardiol. 73(24):3054-3063, 2019 06 25.Local Holdings: Available online from MWHC library: 1995 - present, Available in print through MWHC library:1999-2007.Abstract: BACKGROUND: National guidelines recommend that systolic blood pressure (SBP) in patients with heart failure with reduced ejection fraction (HFrEF) and hypertension be maintained below 130 mm Hg.Abstract: CONCLUSIONS: Among hospitalized older patients with HFrEF, SBP <130 mm Hg is associated with poor outcomes. This association persisted when the analyses were repeated after excluding patients with SBP <110 mm Hg. There is an urgent need for randomized controlled trials to evaluate optimal SBP reduction goals in patients with HFrEF. Copyright Published by Elsevier Inc.Abstract: METHODS: Of the 25,345 patients in the Medicare-linked OPTIMIZE-HF registry, 10,535 had an ejection fraction (EF) <=40%. Of these, 5,615 had stable SBP (<=20 mm Hg admission to discharge variation), and 3,805 (68%) had a discharge SBP <130 mm Hg. Propensity scores for SBP <130 mm Hg, estimated for each of the 5,615 patients, were used to assemble a matched cohort of 1,189 pairs of patients with SBP <130 versus >=130 mm Hg, balanced on 58 baseline characteristics (mean age 76 years; mean EF 28%, 45% women, 13% African American). This process was repeated in 3,946 patients, after excluding 1,669 patients (30% of 5,615) with a discharge SBP <110 mm Hg and assembled a second matched balanced cohort of 1,099 pairs of patients with SBP 110 to 129 mm Hg versus >=130 mm Hg.Abstract: OBJECTIVES: This study sought to determine associations of SBP <130 mm Hg with outcomes in patients with HFrEF.Abstract: RESULTS: Thirty-day all-cause mortality occurred in 7% and 4% of matched patients with SBP <130 mm Hg versus >=130 mm Hg, respectively (hazard ratio [HR]: 1.76; 95% confidence interval [CI]: 1.24 to 2.48; p = 0.001). HRs (95% CIs) for all-cause mortality, all-cause readmission, and HF readmission at 1 year, associated with SBP <130 mm Hg, were 1.32 (1.15 to 1.53; p < 0.001), 1.11 (1.01 to 1.23; p = 0.030), and 1.24 (1.09 to 1.42; p = 0.001), respectively. HRs (95% CIs) for 30-day and 1-year all-cause mortality associated with SBP 110 to 129 mm Hg (vs. >=130 mm Hg) were 1.50 (1.03 to 2.19; p = 0.035), and 1.19 (1.02 to 1.39; p = 0.029), respectively.

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