Lower Blood Pressure at Hospital Admission Increases the Risk of Heart Failure Death

In hospitalized patients with heart failure (HF), lower admission systolic blood pressure (SBP) is linked to an increased risk of one-year death and readmission. The results were published in ESC Heart Failure.

Approximately 64.3 million people suffer from HF globally, and the prevalence is increasing due to extended longevity, high prevalence of risk factors, and improved survival in those with cardiovascular disease. Hospitalized patients hospitalized for HF are at high risk for all-cause death and HF readmission, making it critical to understand the connection between SBP at admission and long-term outcomes of in this population. Despite a high frequency of HF readmission, little is known about the association between admission SBP and HF readmission in the first first year following hospitalization.

To address this issue, the researchers conducted a large prospective multicentre cohort study of 4,896 patients hospitalized for HF in 52 hospitals from 20 provinces in China between August 2016 and May 2018. Individuals with those with lower admission SBP were younger, more likely to be male, have left ventricular ejection fraction <40%, and receive β-blockers, aldosterone antagonists, and diuretics. The population were divided into four groups according to the quartiles of SBP at admission. The researchers used multivariable Cox proportional hazards regression models to assess examine the association between admission SBP and all-cause death and HF readmission within one-year after the date of hospitalization.

Lower Admission BP Augments the Risk of HF Death

According to the results, lower admission SBP was significantly associated with higher all-cause death and there is no threshold, the researchers only observed such an association with HF readmission when admission SBP was lower than 120 mmHg. The investigators noted that compared with the 4th SBP quartile, patients in the 1st SBP quartile had higher risk of all-cause death (HR=1.85; 95% CI, 1.48-2.33; P < 0.001) and HF readmission (HR=1.40; 95% CI, 1.19-1.65, P < 0.001). These associations were found to consistent in most subgroups.

The researchers did not some limitations. First, patients with different admission SBP may receive different medications during follow up, but the researchers did not collate extensive data about the follow-up medications, which could be confounders. Secondly, they noted, although they minimized for the risk of confounding by a thorough multivariate adjustment, other unknown confounders could have been missed.

“Lower admission SBP was significantly associated with higher risk of all-cause death and there is no threshold, while such an association with HF readmission was only observed when admission SBP was lower than 120 mmHg,” the researchers concluded.

“These associations were consistent among various clinically important subgroups. These findings can improve risk stratification at very early stage and facilitate more effective management strategies for patients hospitalized for HF.”