Systolic blood pressure reduction during treatment of acute decompensated heart failure increased odds of worsening renal function by 30% per 10 mmHg decrease in blood pressure.
RCT (n=386)
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Yes
Does significant blood pressure reduction during acute decompensated heart failure treatment cause worsening renal function, and does this affect mortality?
Worsening renal function driven by blood pressure reduction during acute decompensated heart failure treatment is not associated with increased mortality, unlike worsening renal function occurring without blood pressure reduction.
Effect estimate: OR 1.3 per 10 mmHg reduction (95% CI null)
p-value: p=<0.001
Aims One of the primary determinants of blood flow in regional vascular beds is perfusion pressure. Our aim was to investigate if reduction in blood pressure during the treatment of decompensated heart failure would be associated with worsening renal function (WRF). Our secondary aim was to evaluate the prognostic significance of this potentially treatment‐induced form of WRF. Methods and results Subjects included in the Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness (ESCAPE) trial limited data were studied (386 patients). Reduction in systolic blood pressure (SBP) was greater in patients experiencing WRF (−10.3 ± 18.5 vs. −2.8 ± 16.0 mmHg, P median) was associated with greater doses of in‐hospital oral vasodilators ( P ≤ 0.017), thiazide diuretic use ( P = 0.035), and greater weight reduction ( P = 0.023). In patients with SBP‐reduction, WRF was not associated with worsened survival adjusted hazard ratio (HR) = 0.76, P = 0.58. However, in patients without SBP‐reduction, WRF was strongly associated with increased mortality (adjusted HR = 5.3, P < 0.001, P interaction = 0.001). Conclusion During the treatment of decompensated heart failure, significant blood pressure reduction is strongly associated with WRF. However, WRF that occurs in the setting of SBP‐reduction is not associated with an adverse prognosis, whereas WRF in the absence of this provocation is strongly associated with increased mortality. These data suggest that WRF may represent the final common pathway of several mechanistically distinct processes, each with potentially different prognostic implications.
Testani et al. (Tue,) conducted a rct in acute decompensated heart failure (n=386). systolic blood pressure reduction vs. null was evaluated on worsening renal function (WRF) following blood pressure reduction (OR 1.3 per 10 mmHg reduction, 95% CI null, p=<0.001). Systolic blood pressure reduction during treatment of acute decompensated heart failure increased odds of worsening renal function by 30% per 10 mmHg decrease in blood pressure.