Impact of changes in blood pressure during the treatment of acute decompensated heart failure on renal and clinical outcomes†
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Key result
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.
Why the study?
Does significant blood pressure reduction during acute decompensated heart failure treatment cause worsening renal function, and does this affect mortality?
Population
Hospitalized patients with acute decompensated heart failure, LVEF ≤30%, and SBP ≤125 mmHg
Comparison
Significant in-hospital reduction in systolic… vs No significant reduction in systolic blood…
Design
Cohort, Randomized to therapy guided by pulmonary artery catheter vs. clinical…
Follow-up
180 days
Authors
Discussion
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Implication
Worsening renal function tied to systolic blood pressure reduction may not worsen survival; leaves open optimal targets during acute decompensated heart failure treatment.
Key Points
- The study aims to examine the relationship between blood pressure reduction during treatment of acute decompensated heart failure and worsening renal function.
- Data from the ESCAPE trial were analyzed, including 386 patients.
- Systolic blood pressure changes and renal function outcomes were assessed during treatment.
- Associations between SBP changes, medication use, and mortality were evaluated.
- Significant SBP reduction was observed in patients with worsening renal function (−10.3 ± 18.5 vs. −2.8 ± 16.0 mmHg, P < 0.001).
- In patients with SBP reduction, worsening renal function did not affect survival (HR = 0.76, P = 0.58).
- Without SBP reduction, worsening renal function significantly increased mortality risk (HR = 5.3, P < 0.001).
Study Design
Type
RCT (n=386)
Blinding
null
Randomization
null
Multicenter
Yes
Structured PICO
Does significant blood pressure reduction during acute decompensated heart failure treatment cause worsening renal function, and does this affect mortality?
P
Population
Hospitalized patients with acute decompensated heart failure, LVEF ≤30%, and SBP ≤125 mmHg
I
Intervention
Significant in-hospital reduction in systolic blood pressure (SBP-reduction) during treatment
C
Comparator
No significant reduction in systolic blood pressure
O
Outcome
Relationship between in-hospital reduction in blood pressure and worsening renal function (WRF), and their associated interaction with all-cause mortalityhard clinical
Main Result
Effect estimate: OR 1.3 per 10 mmHg reduction (95% CI null)
p-value: p=<0.001
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.
Limitations
- Post-hoc nature of the study
- Residual confounding cannot be excluded
- Limited generalizability due to stringent inclusion/exclusion criteria
- Analysis of intravenous agents limited by their short half-life since blood pressure change was assessed from admission to discharge
Cite This Study
Testani et al. (2011) conducted an 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.
Topics
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