Why the study?
Hypertensive acute decompensated heart failure is clinically relevant but has been less intensively evaluated regarding its prognostic nature and pathophysiology.
Does elevated systolic blood pressure combined with elevated heart rate at presentation predict lower cardiovascular mortality in patients with first-time acute decompensated heart failure?
Does elevated systolic blood pressure combined with elevated heart rate at presentation predict lower cardiovascular mortality in patients with first-time acute decompensated heart failure?
In patients presenting with first-time acute decompensated heart failure, the combination of elevated systolic blood pressure (>140 mmHg) and elevated heart rate is a strong predictor of lower cardiovascular mortality.
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Combined elevated HR and SBP in HT-ADHF was associated with lower CV mortality; leaves open whether sympathetic activation modifies prognosis, warranting prospective study.
Despite its clinical relevance, a subclass of acute decompensated heart failure (ADHF) with elevated blood pressure, known as hypertensive ADHF (HT-ADHF), has been less intensively evaluated. This study aimed to characterize the prognostic nature and pathophysiology of HT-ADHF. A total of 509 consecutive patients with first-time ADHF hospitalization were subjects of the study. Participants were divided into two groups: an HT-ADHF group (systolic blood pressure, SBP > 140 mmHg at presentation) and a non-HT-ADHF group (SBP ≤ 140 mmHg). Median follow-up duration measured 253 days. Unadjusted Kaplan-Meier analysis demonstrated both a lower cardiovascular mortality rate in the HT-ADHF group and similar incidences of heart failure rehospitalization in both groups. Adjusted Cox hazard analysis showed an association of elevated SBP at presentation with significantly lower cardiovascular mortality, though no such association was observed with heart failure rehospitalization. Moreover, elevated heart rate in combination with elevated SBP at presentation predicted a significantly lower risk of cardiovascular mortality (Hazard Ratio: 0.32, 95% CI: 0.14-0.77, P = 0.01). Also, significantly lower cardiovascular mortality was observed in this subtype, compared with other types of ADHF.
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Hiki et al. (2020) studied this question.
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