Key result
Low systolic blood pressure (<100 mmHg) on the day following hospitalization independently predicted a higher risk of all-cause death (HR 1.868) in hospitalized patients with HFpEF.
Why the study?
Although admission SBP guides initial acute HF classification and treatment, the prognostic significance of SBP following initial treatment remains unclear.
Does low systolic blood pressure on the day following hospitalization predict post-discharge mortality and rehospitalization in patients with HFpEF?
Cohort (n=525)
Yes
Does low systolic blood pressure on the day following hospitalization predict post-discharge mortality and rehospitalization in patients with HFpEF?
Hazard Ratio: 1.868 (95% CI 1.024–3.407)
p-value: p=0.042
Low systolic blood pressure (<100 mmHg) on the day following hospitalization for acute HFpEF is an independent predictor of post-discharge mortality and heart failure rehospitalization.
May inform early risk stratification in acute HFpEF; hypothesis-generating for whether SBP is a modifiable target.
The clinical scenario, which is based on systolic blood pressure (SBP) upon admission, is useful for classifying and determining initial treatment for acute heart failure (HF). However, the prognostic significance of SBP following the initial treatment is unclear.The Japanese Heart Failure Syndrome with Preserved Ejection Fraction (JASPER) registry is a nationwide, observational, and prospective registration of consecutive Japanese patients hospitalized with HF with preserved ejection fraction (HFpEF) and left ventricular ejection fraction ≥ 50%. We divided 525 patients into three groups based on their SBP on the day following hospitalization: high (SBP > 140 mmHg, n = 72, 13.7%); normal (100 ≤ SBP ≤ 140 mmHg, n = 379, 72.2%); and low (SBP < 100 mmHg, n = 74, 14.1%) groups. This analysis had two primary endpoints: (1) all-cause death and (2) all-cause death or rehospitalization for HF. In the Kaplan-Meier analysis, both of the endpoints were the highest in the low group (Log-Rank < 0.05, respectively). Compared to the normal and high groups, the low group demonstrated a higher prevalence of atrial fibrillation (67.1%, 63.9%, and 47.8%, P = 0.026) and the lowest left ventricular outflow tract velocity time integral determined by echocardiography (16.4 cm, 19.4 cm, and 23.3 cm, P = 0.001). In the multivariable Cox proportional hazard analysis, low SBP on the day following hospitalization was an independent predictor of all-cause death (hazard ratio 1.868, 95% confidence interval 1.024-3.407, P = 0.042) and the composite endpoint (hazard ratio 1.660, 95% confidence interval 1.103-2.500, P = 0.015).Classification based on SBP on the day following initial treatment predicts post-discharge prognosis in hospitalized patients with HFpEF.
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Sato et al. (2019) conducted a cohort in Heart Failure with Preserved Ejection Fraction (HFpEF) (n=525). Low systolic blood pressure (<100 mmHg) on the day following hospitalization vs. Normal systolic blood pressure (100-140 mmHg) on the day following hospitalization was evaluated on All-cause death (HR 1.868, 95% CI 1.024-3.407, p=0.042). Low systolic blood pressure (<100 mmHg) on the day following hospitalization independently predicted a higher risk of all-cause death (HR 1.868) in hospitalized patients with HFpEF.
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