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JACC Heart Fail. 2017 Nov;5(11):810-819. doi: 10.1016/j.jchf.2017.08.015.

Reverse J-Curve Relationship Between On-Treatment Blood Pressure and Mortality in Patients With Heart Failure.

Author information

1
Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
2
Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea. Electronic address: hylee612@snu.ac.kr.
3
Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea.
4
Sungkyunkwan University College of Medicine, Seoul, South Korea.
5
Chungbuk National University College of Medicine, Cheongju, South Korea.
6
Kyungpook National University College of Medicine, Daegu, South Korea.
7
The Catholic University of Korea, Seoul, South Korea.
8
Yonsei University College of Medicine, Seoul, South Korea.
9
Seoul National University Bundang Hospital, Seongnam, South Korea.
10
Yonsei University Wonju College of Medicine, Wonju, South Korea.
11
Heart Research Center of Chonnam National University, Gwangju, South Korea.

Abstract

OBJECTIVES:

This study aimed to assess the relationship between on-treatment blood pressure (BP) and clinical outcomes of patients with heart failure (HF).

BACKGROUND:

Lower BP has been reported to be related to increased mortality in various cardiovascular diseases. The optimal BP level for patients already experiencing HF is contentious.

METHODS:

The Korean Acute Heart Failure registry prospectively enrolled a total of 5,625 consecutive patients hospitalized for acute HF in 10 tertiary university hospitals in Korea between March 2011 and February 2014. Clinical profiles including BP were collected at admission, discharge, and during outpatient follow-up. Mean on-treatment BP was calculated from BP at discharge and at each follow-up visit. We evaluated the effects of mean on-treatment BP on the clinical outcomes of patients.

RESULTS:

Patients were followed up for a median 2.2 years. One-year mortality after discharge was 18.2%. The relationship between on-treatment BP and all-cause mortality followed a reversed J-curve relationship. A nonlinear, multivariable Cox proportional hazard model identified a nadir of systolic and diastolic BPs of 132.4/74.2 mm Hg in patients, for whom the mortality rate was lowest (p < 0.0001). The relationship with increased mortality above and below the reference BP was more definitive for diastolic BP and for HF with a preserved ejection fraction.

CONCLUSIONS:

Systolic and diastolic BPs <130/70 mm Hg at discharge and during follow-up was associated with worse survival in HF patients. These data suggest that the lowest BP possible might not be an optimal target for HF patients. Further studies should establish a proper BP goal in HF patients. (Registry [Prospective Cohort] for Heart Failure in Korea [KorAHF]; NCT01389843).

KEYWORDS:

J-curve; blood pressure; heart failure; heart failure with preserved ejection fraction; heart failure with reduced ejection fraction; mortality

PMID:
29096790
DOI:
10.1016/j.jchf.2017.08.015
[Indexed for MEDLINE]
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