48-hour BPRI trajectories and 28-day mortality in vasoactive-supported hypertensive heart disease with heart failure

Q: What are the key findings of this study?

Among vasoactive-supported critically ill patients with hypertensive heart disease and heart failure, a persistently low BPRI trajectory was associated with a higher risk of 28-day mortality (HR 3.01).

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Hypertensive heart disease with heart failure (n=1338). Intervention: Persistently low BPRI trajectory vs. High-Stable BPRI trajectory. Primary outcome: 28-day all-cause mortality (HR 3.01, 95% CI 1.71-5.30, p=<0.0001).

Q: What does this research mean for the field?

In vasoactive-supported critically ill patients with hypertensive heart disease and heart failure, a persistently low Blood Pressure Response Index (BPRI) trajectory over the first 48 hours of ICU admission is associated with significantly higher 28-day mortality. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To assess the prognostic value of dynamic 48-hour Blood Pressure Response Index (BPRI) trajectories for predicting 28-day all-cause mortality in critically ill patients with hypertensive heart disease and heart failure receiving vasoactive support.

Zijian Huang; Zefeng Chen; Liu Zhuxuan; Jiebin Zheng; Bo Chen

doi:10.1038/s41598-026-70610-6

September 6, 2026Scientific ReportsOpen Access

48-hour BPRI trajectories and 28-day mortality in vasoactive-supported hypertensive heart disease with heart failure

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Key result

Persistently low BPRI trajectory linked to ~201% higher 28-day mortality in critically ill HF patients.

HR 3.01
95% CI 1.71-5.30
P<0.0001
n=1,338

Why the study?

Hypertensive heart disease complicated by heart failure carries high ICU mortality, but the prognostic value of dynamic Blood Pressure Response Index trajectories remains unclear.

Does a persistently low 48-hour BPRI trajectory predict higher 28-day mortality in critically ill adults with hypertensive heart disease and heart failure requiring vasoactive support?

Key Points

To assess the prognostic value of dynamic 48-hour Blood Pressure Response Index (BPRI) trajectories for predicting 28-day all-cause mortality in critically ill patients with hypertensive heart disease and heart failure receiving vasoactive support.
Retrospective cohort study analyzing critically ill adults with hypertensive heart disease and heart failure on vasoactive support in the first 48 hours of ICU admission across MIMIC-IV v3.1 (N=1,078) and eICU-CRD v2.0 (N=260).
Group-based trajectory modeling identified 48-hour log-transformed BPRI patterns, calculated as the ratio of mean arterial pressure to vasoactive-inotropic score across 4-hour windows.
Associations with 28-day all-cause mortality were evaluated using multivariable Cox proportional hazards regression, logistic regression, and restricted cubic splines.
Five BPRI trajectories were identified in both cohorts, with the persistently low BPRI group experiencing the highest 28-day mortality (37.58% in MIMIC-IV vs. 4.71% in the high-stable group, P < 0.001; 37.21% in eICU-CRD vs. 16.95% in the high-stable group).
Persistently low BPRI independently predicted 28-day mortality compared to the high-stable group in both the MIMIC-IV cohort (adjusted HR 3.01, 95% CI 1.71–5.30; adjusted OR 3.12, 95% CI 1.64–5.93) and the eICU-CRD cohort (adjusted OR 2.37, 95% CI 1.13–4.56).
The 48-hour mean log-BPRI demonstrated a near-linear inverse relationship with 28-day mortality, and the 48-hour trajectory model showed the highest apparent and optimism-corrected discrimination.

Study Design

Type

Cohort (n=1,338)

Multicenter

Yes

Structured PICO

Does a persistently low 48-hour BPRI trajectory predict higher 28-day mortality in critically ill adults with hypertensive heart disease and heart failure requiring vasoactive support?

P

Population

1,338 critically ill adults with hypertensive heart disease and heart failure receiving vasoactive support, followed for 28 days.

E

Exposure

Persistently low 48-hour Blood Pressure Response Index (BPRI) trajectory (BPRI defined as the ratio of mean arterial pressure to the Vasoactive-Inotropic Score)

C

Comparator

Other BPRI trajectories (specifically the High-Stable BPRI trajectory group as the reference)

O

Outcome

28-day all-cause mortalityhard clinical

Main Result

Hazard Ratio: 3.01 (95% CI 1.71–5.3)

Absolute Event Rate: 37.58% vs 4.71%

p-value: p=<0.0001

In critically ill patients with hypertensive heart disease and heart failure requiring vasoactive support, a persistently low 48-hour Blood Pressure Response Index (BPRI) trajectory is strongly associated with increased 28-day mortality.

Limitations

Retrospective observational design precludes causal inference
Residual confounding from unmeasured factors such as echocardiographic parameters, frailty, and goals-of-care decisions
Information on the timing and triggers of vasoactive dose escalation was unavailable
Cause-specific mortality data were lacking
BPRI reflects macrovascular responsiveness but not microcirculatory status
Both databases originate from U.S. ICUs, limiting generalizability

Implication

May warrant closer monitoring in vasoactive-supported patients; extends BPRI prognostication in hypertensive HF but remains hypothesis-generating.

Abstract

Hypertensive heart disease (HHD) complicated by heart failure is associated with high mortality in intensive care units. The Blood Pressure Response Index (BPRI), the ratio of mean arterial pressure to vasoactive-inotropic score, integrates hemodynamic targets and treatment intensity, yet the prognostic value of its dynamic trajectories in this population remains unclear. This retrospective cohort study used MIMIC-IV v3.1 as the development cohort and eICU-CRD v2.0 as an independent replication cohort for trajectory patterns and trajectory–outcome associations. We included critically ill adults with a primary discharge code for hypertensive heart disease with heart failure who received vasoactive support during the first 48 h after ICU admission. Log-transformed BPRI values per 4-h window over 48 h were analyzed via group-based trajectory modeling. The primary outcome was 28-day all-cause mortality, assessed with multivariable Cox regression, logistic regression, and restricted cubic spline analysis. 1,078 patients from MIMIC-IV and 260 from eICU-CRD were analyzed. Five distinct BPRI trajectories were identified in both cohorts. The Persistently low BPRI group had the highest 28-day mortality (37.58% in MIMIC-IV; 37.21% in eICU-CRD). The fully adjusted hazard ratio for this high-risk group was 3.01 (95% CI 1.71–5.30) in the MIMIC-IV cohort, and the corresponding adjusted odds ratio was 2.37 (95% CI 1.13–4.56) in the eICU-CRD replication cohort. The 48-h mean log-BPRI showed a near-linear inverse association with mortality, with no significant subgroup interactions. In incremental predictive analyses, the 48-h BPRI trajectory model showed the highest apparent and optimism-corrected discrimination among the evaluated models. Among vasoactive-supported critically ill patients with discharge-coded hypertensive heart disease and heart failure, persistently low BPRI was associated with higher 28-day mortality.

Discussion

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Cite This Study

Huang et al. (2026) conducted a cohort in Hypertensive heart disease with heart failure (n=1,338). Persistently low BPRI trajectory vs. High-Stable BPRI trajectory was evaluated on 28-day all-cause mortality (HR 3.01, 95% CI 1.71-5.30, p=<0.0001). Among vasoactive-supported critically ill patients with hypertensive heart disease and heart failure, a persistently low BPRI trajectory was associated with a higher risk of 28-day mortality (HR 3.01).

synapsesocial.com/papers/6a9fd75858e84d0ff5b45f84 https://doi.org/10.1038/s41598-026-70610-6

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48-hour BPRI trajectories and 28-day mortality in vasoactive-supported hypertensive heart disease with heart failure

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

48-hour BPRI trajectories and 28-day mortality in vasoactive-supported hypertensive heart disease with heart failure

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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