TY  - BOOK
AU  - Gill, Gauravpal S
AU  - Lam, Phillip H
TI  - Systolic Blood Pressure and Outcomes in Patients With Heart Failure With Reduced Ejection Fraction
SN  - 0735-1097
PY  - 2019///
KW  - *Blood Pressure
KW  - *Heart Failure
KW  - *Stroke Volume
KW  - *Ventricular Dysfunction, Left
KW  - Aged
KW  - Blood Pressure Determination/sn [Statistics & Numerical Data]
KW  - Female
KW  - Heart Failure/di [Diagnosis]
KW  - Heart Failure/mo [Mortality]
KW  - Heart Failure/pp [Physiopathology]
KW  - Heart Failure/th [Therapy]
KW  - Hospitalization/sn [Statistics & Numerical Data]
KW  - Humans
KW  - Male
KW  - Medicare/sn [Statistics & Numerical Data]
KW  - Mortality
KW  - Registries
KW  - Risk Factors
KW  - United States/ep [Epidemiology]
KW  - Ventricular Dysfunction, Left/ep [Epidemiology]
KW  - Ventricular Dysfunction, Left/pp [Physiopathology]
KW  - MedStar Heart & Vascular Institute
KW  - MedStar Washington Hospital Center
KW  - Medicine/Internal Medicine
KW  - Journal Article
KW  - Research Support, N.I.H., Extramural
KW  - Research Support, Non-U.S. Gov't
N1  - Available online from MWHC library: 1995 - present, Available in print through MWHC library:1999-2007
N2  - 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; 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; 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; OBJECTIVES: This study sought to determine associations of SBP <130 mm Hg with outcomes in patients with HFrEF; 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
UR  - https://dx.doi.org/10.1016/j.jacc.2019.04.022
ER  -