Systolic blood pressure reduction during the first 24 h in acute heart failure admission: friend or foe?

Cotter, G. et al. (2018) Systolic blood pressure reduction during the first 24 h in acute heart failure admission: friend or foe? European Journal of Heart Failure, 20(2), pp. 317-322. (doi: 10.1002/ejhf.889) (PMID:28871621)

Abstract

Aims: Changes in systolic blood pressure (SBP) during an admission for acute heart failure (AHF), especially those leading to hypotension, have been suggested to increase the risk for adverse outcomes. Methods and results: We analysed associations of SBP decrease during the first 24 h from randomization with serum creatinine changes at the last time-point available (72 h), using linear regression, and with 30- and 180-day outcomes, using Cox regression, in 1257 patients in the VERITAS study. After multivariable adjustment for baseline SBP, greater SBP decrease at 24 h from randomization was associated with greater creatinine increase at 72 h and greater risk for 30-day all-cause death, worsening heart failure (HF) or HF readmission. The hazard ratio (HR) for each 1 mmHg decrease in SBP at 24 h for 30-day death, worsening HF or HF rehospitalization was 1.01 [95% confidence interval (CI) 1.00–1.02; P = 0.021]. Similarly, the HR for each 1 mmHg decrease in SBP at 24 h for 180-day all-cause mortality was 1.01 (95% CI 1.00–1.03; P = 0.038). The associations between SBP decrease and outcomes did not differ by tezosentan treatment group, although tezosentan treatment was associated with a greater SBP decrease at 24 h. Conclusions: In the current post hoc analysis, SBP decrease during the first 24 h was associated with increased renal impairment and adverse outcomes at 30 and 180 days. Caution, with special attention to blood pressure monitoring, should be exercised when vasodilating agents are given to AHF patients.

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: McMurray, Professor John and Cleland, Professor John
• Authors: Cotter, G., Metra, M., Davison, B. A., Jondeau, G., Cleland, J. G.F., Bourge, R. C., Milo, O., O'Connor, C. M., Parker, J. D., Torre-Amione, G., van Veldhuisen, D. J., Kobrin, I., Rainisio, M., Senger, S., Edwards, C., McMurray, J. J.V., and Teerlink, J. R.
• Subjects: R Medicine > R Medicine (General)
• College/School: College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health; College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Robertson Centre
• Journal Name: European Journal of Heart Failure
• Publisher: Wiley
• ISSN: 1388-9842
• ISSN (Online): 1879-0844
• Published Online: 04 September 2017
• Copyright Holders: Copyright © 2017 The Authors and European Society of Cardiology
• First Published: First published in European Journal of Heart Failure 20(2): 317-322
• Publisher Policy: Reproduced in accordance with the publisher copyright policy