Pulse Pressure as a Simple Risk Marker in Heart Failure - Association With One Year Mortality and Readmission

Objective: Pulse pressure reflects arterial stiffness and vascular ageing and may provide prognostic information in heart failure. We evaluated the independent prognostic value of pulse pressure in hospitalised heart failure patients. Design and method: We analysed a retrospective cohort of 619 consecutive patients admitted with heart failure. Pulse pressure was calculated from office systolic and diastolic blood pressure values, and high pulse pressure was defined as sixty millimetres of mercury or higher. The primary endpoint was one-year mortality. The secondary endpoint was a one-year composite of mortality, emergency department admission and hospital admission. Survival analyses were performed using Kaplan–Meier curves with log-rank testing. Independent associations were evaluated using multivariable Cox proportional hazards models adjusted for sex, hypertension, diabetes mellitus, dyslipidaemia and smoking status. Results: The sample included 42.0 per cent men (259 of 619) with a mean age of 79 years (range 42 to 103). The population had a high prevalence of cardiovascular risk factors and comorbidities, including hypertension (61 per cent), diabetes mellitus (37 per cent), dyslipidaemia (28 per cent) and smoking (5 per cent), as well as atrial fibrillation (35 per cent), chronic kidney disease (23 per cent), chronic obstructive lung disease (21 per cent) and coronary artery disease (16 per cent). Patients with high pulse pressure had worse one-year mortality (log-rank 4.52) and a tendency towards worse one-year event-free survival for the composite endpoint (log-rank 3.32). In multivariable analysis, high pulse pressure independently predicted one-year mortality (hazard ratio 1.68, p value 0.048). The association with the composite endpoint was directionally consistent but not statistically significant (hazard ratio 1.78, p value 0.157). Conclusions: A pulse pressure of sixty millimetres of mercury or higher at admission identified heart failure patients at increased risk of one-year mortality and may add pragmatic risk stratification using routinely available clinical data. Prospective studies should validate optimal thresholds and assess whether pulse pressure–guided management improves outcomes.