Key result
A 1-SD increment in admission mean arterial pressure was associated with lower 30-day mortality in HFpEF (OR 0.63; 95% CI 0.43-0.92; P=0.018) and lower 1-year mortality in HFmrEF and HFrEF.
Why the study?
It remained unknown whether admission mean and pulse pressure are associated with short- and long-term mortality in Chinese patients with HFpEF, HFmrEF, and HFrEF.
Do admission mean arterial pressure and pulse pressure predict short- and long-term mortality in patients with acute decompensated heart failure?
Cohort (n=2,706)
Do admission mean arterial pressure and pulse pressure predict short- and long-term mortality in patients with acute decompensated heart failure?
Odds Ratio: 0.63 (95% CI 0.43–0.92)
p-value: p=0.018
Lower admission mean arterial pressure is associated with higher short-term mortality across all HF subtypes, while higher pulse pressure predicts higher long-term mortality in men and in HFpEF.
Supports MAP as short-term mortality marker across acute HF subtypes; leaves open whether targeted BP strategies alter outcomes.
BACKGROUND: It remains unknown whether admission mean (MAP) and pulse pressure (PP) pressure are associated with short- and long-term mortality in Chinese patients with heart failure with preserved (HFpEF), mid-range (HFmrEF), and reduced (HFrEF) ejection fraction. METHODS: In 2,706 acute decompensated heart failure (HF) patients, we assessed the risk of 30-day, 1-year, and long-term (>1 year) mortality with 1-SD increment in MAP and PP, using multivariable logistic and Cox regression, respectively. RESULTS: During a median follow-up of 4.1 years, 1,341 patients died. The 30-day, 1-year, and long-term mortality were 3.5%, 16.7%, and 39.4%, respectively. A lower MAP was associated with a higher risk of 30-day mortality in women (P = 0.023) and a higher risk of 30-day and 1-year mortality in men (P ≤ 0.006), while higher PP predicted long-term mortality in men (P ≤ 0.014) with no relationship observed in women. In adjusted analyses additionally accounted for PP, 1-SD increment in MAP was associated with 30-day mortality in HFpEF (odds ratio [OR], 0.63; 95% CI, 0.43 to 0.92; P = 0.018), with 1-year mortality in HFmrEF (OR, 0.46; 95% CI, 0.32 to 0.66; P < 0.001) and HFrEF (OR, 0.54; 95% CI, 0.40 to 0.72; P < 0.001). In the adjusted model additionally accounted for MAP, 1-SD increment in PP was associated with long-term mortality in HFpEF (hazard ratio, 1.16; 95% CI, 1.05 to 1.28; P = 0.003). CONCLUSIONS: A lower MAP was associated with a higher risk of short-term mortality in all HF subtypes, while a higher PP predicted a higher risk of long-term mortality in men and in HFpEF. Our observations highlight the clinical importance of admission blood pressure for risk stratification in HF subtypes.
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Chen et al. (2022) conducted a cohort in Acute Decompensated Heart Failure (n=2,706). Admission mean arterial pressure (MAP) and pulse pressure (PP) vs. Lower MAP/PP (1-SD increment analysis) was evaluated on 30-day, 1-year, and long-term (>1 year) mortality (OR 0.63, 95% CI 0.43-0.92, p=0.018). A 1-SD increment in admission mean arterial pressure was associated with lower 30-day mortality in HFpEF (OR 0.63; 95% CI 0.43-0.92; P=0.018) and lower 1-year mortality in HFmrEF and HFrEF.
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