Quantifying the paradoxical effect of higher systolic blood pressure on mortality in chronic heart failure

International Centre for Circulatory Health, St Mary's Hospital and Imperial College, London, UK.
Heart (British Cardiac Society) (Impact Factor: 5.6). 01/2009; 95(1):56-62. DOI: 10.1136/hrt.2007.134973
Source: PubMed


Although higher blood pressures are generally recognised to be an adverse prognostic marker in risk assessment of cardiology patients, its relationship to risk in chronic heart failure (CHF) may be different.
To examine systematically published reports on the relationship between blood pressure and mortality in CHF.
Medline and Embase were used to identify studies that gave a hazard or relative risk ratio for systolic blood pressure in a stable population with CHF. Included studies were analysed to obtain a unified hazard ratio and quantify the degree of confidence.
10 studies met the inclusion criteria, giving a total population of 8088, with 29 222 person-years of follow-up. All studies showed that a higher systolic blood pressure (SBP) was a favourable prognostic marker in CHF, in contrast to the general population where it is an indicator of poorer prognosis. The decrease in mortality rates associated with a 10 mm Hg higher SBP was 13.0% (95% CI 10.6% to 15.4%) in the heart failure population. This was not related to aetiology, ACE inhibitor or beta blocker use.
SBP is an easily measured, continuous variable that has a remarkably consistent relationship with mortality within the CHF population. The potential of this simple variable in outpatient assessment of patients with CHF should not be neglected. One possible application of this information is in the optimisation of cardiac resynchronisation devices.

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Available from: Justin Davies, Jan 26, 2015
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    • "Moreover, a fall in perfusion pressure may have adverse consequences in heart failure, including activation of the renin–angiotensin and sympathetic nervous systems, leading to sodium retention and further derangement in blood flow distribution . A low blood pressure is a bad prognostic sign in heart failure (Raphael et al., 2009). ERAs have worsened arterial oxygen saturation Table 1 Clinical trials investigating the effects of ERA therapy on symptoms, ventricular remodeling, or clinical outcome in patients with heart failure. "
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    • "The pressure measured is the main criterion for diagnosis of acute heart failure (vasoactive shock). In recent years the importance of systolic pressure as a predictor of mortality in patients with acute and chronic [25] forms of heart failure has been recalled. Low pressure in patients suffering from chronic forms of heart failure is recognized as a positive prognostic factor of mortality. "

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