Key result
Admission BP exceeding 160/88 mmHg is linked to ~177% higher two-year mortality in acute aortic dissection.
Why the study?
Does admission blood pressure level affect short- and long-term all-cause mortality in patients with acute aortic dissection?
Cohort (n=700)
Yes
Does admission blood pressure level affect short- and long-term all-cause mortality in patients with acute aortic dissection?
Effect estimate: HR 2.77 (95% CI 1.22–6.27)
p-value: p=0.015
Admission blood pressure has a J-shaped relationship with long-term mortality in acute aortic dissection, suggesting an optimal target range of 130-160/80-88 mmHg to balance aortic wall tension and end-organ perfusion.
May support targeting admission BP 130-160/80-88 mmHg in acute aortic dissection; hypothesis-generating and should not yet change practice.
The combined effect of admission systolic (SBP) and diastolic blood pressure (DBP) on short- and long-term all-cause mortality in patients with acute aortic dissection (AAD) remains insufficiently characterized. This retrospective cohort study investigated these associations to identify potential blood pressure thresholds linked to minimized mortality risk. We utilized restricted cubic splines (RCS) to characterize nonlinear associations, identifying specific BP levels (nadirs) associated with the lowest risk of mortality. Segmented analysis was employed to assess linear relationships flanking these nadirs, and multivariable Cox regression models were applied to evaluate the impact of different BP ranges after adjusting for potential confounders. Our results revealed a significant J-shaped correlation for admission SBP and DBP regarding long-term mortality. Mortality risks escalated at SBP levels departing from a nadir of 143.4 mmHg and at DBP departing from 83.7 mmHg. Specifically, an admission SBP/DBP range of 130–160/80–88 mmHg was associated with the lowest long-term all-cause mortality risk, serving as the risk-nadir interval in this cohort. Other independent predictors of mortality included advanced age, myocardial infarction, higher heart rate, history of heart bypass, elevated NT-proBNP and hsTNT, while type B AAD, normal heart rhythm and surgery within 24 h were protective factors. In conclusion, admission SBP and DBP exhibit significant nonlinear associations (J-shaped) with long-term all-cause mortality in AAD. The identified 130–160/80–88 mmHg range represents a potential reference interval for admission hemodynamic management, while acknowledging the need for validation in diverse clinical settings.
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Chen et al. (2026) conducted a cohort in acute aortic dissection (n=700). admission blood pressure vs. nadir blood pressure range 130–160/80–88 mmHg was evaluated on Two-year all-cause mortality (HR 2.77, 95% CI 1.22–6.27, p=0.015). Admission blood pressure within the range of 130–160/80–88 mmHg is associated with a reduced risk of two-year all-cause mortality in patients with acute aortic dissection, with HR 2.77 indicating nearly three-fold increased mortality risk for values above 160/89-100 mmHg.
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