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Relationship between on-treament blood pressure and outcomes in patients with heart failure
Session:
CO7 - Insuficiência Cardíaca
Speaker:
David Cabrita Roque
Congress:
CPC 2019
Topic:
D. Heart Failure
Theme:
10. Chronic Heart Failure
Subtheme:
10.4 Chronic Heart Failure – Treatment
Session Type:
Comunicações Orais
FP Number:
---
Authors:
David Cabrita Roque; Miguel Santos; João Augusto; Daniel Candeias Faria; João Baltazar Ferreira; Hilaryano Ferreira; Marco Beringuilho; Ana Oliveira Soares; Carlos Sequeira De Morais
Abstract
<p><strong>Background: </strong>Blood pressure (BP) is a well known and studied cardiovascular (CV) risk factor. However when CV disease is established, the optimal level of BP is not well studied, and some works had shown that lower BP is related to increased mortality.</p> <p><strong>Purpose:</strong> Evalute in pts admitted for acute decompensated heart failure (ADHF), the relationship between BP at admission, during hospitalization and at hospital discharge with clinical outcomes..</p> <p><strong>Methods: </strong>Retrospective study of 258 consecutive pts admitted for ADHF, defined by the presence of ≥ 2 signs or symptoms of HF. Admission and discharge values of systolic blood pressure (SBP) were recorded, along with clinical, laboratory and therapeutic variables. We divided our population according to the 1st SBP registered at hospital admission and at discharge: group 1 <130mmHg (31.8 and 64.3%, respectively); group 2 130-160mmHg (37.2 and 28.7%, respectively) and group 3 >160mmHg (31 and 3.9%, respectively). We also evaluated patients’ medication before admission, during hospitalization and at discharge.</p> <p><strong>Results: </strong>45.7% male, mean age of 74.6±16.6 years. Emergent hospital admission was more frequent in admission group 3 (61.3% vs 28.1% in group 2 and 28.1% in group 1, p<0.001). Admission group 3 also presented more frequently with acute pulmonary oedema (66.3% vs 17.7% in group 2 and 13.4% in group 1, p<0.001). Chronic renal disease was less frequent in admission group 3 (20% vs 37.5% in group 2 and 31.7% in group 1, p=0.040); previous acute coronary syndrome was more frequent in admission group 1 (45.1% vs 29.2% in group 2 and 25% in group 3, p=0.015). Ejection fraction was significantly lower for patients in both admission and discharge group 3 (admission: mean 42% group 3 vs 58.8% group 1 vs 74.4% for group 2, p=0.019; discharge: mean 26% group 3 vs 65.7% group 1 vs 47.2% group 2, p=0.004). There were no significant differences in hospital mortality between admission SBP groups (7.3% group 1, 9.4% group 2, 7.5% group 3, p=0.855). Interestingly, patients in admission group 3 had shorter lengths of stay (mean 9.4 vs 13.5 for group 2 and 14.2 days for group 3, p<0.001). Of note, prior prescription of ACEIs/ARB and beta blockers was unrelated to admission SBP categories. There were no differences in readmission rates for ADHF at 1, 3, 6, 9 and 12 months after discharge, according to SBP categories. There was a trend for patients in groups 1 and 3 to have higher mortality rates after discharge (14.5% for group 1 and 10% for group 3 vs 5.4% for group 2, p=0.128), suggesting a J-shaped curve for mortality according to SBP.</p> <p><strong>Conclusions: </strong>During hospitalization SBP does not seem to have an association with mortality rates; however, according to the SBP values at discharge, those patients with the highest and the lowest values are those with higher risk of mortality at 1y FUP, suggesting that in HF, SBP has a J curve and that the least possible BP may not be an adequate treatment target.</p>
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