Systolic blood pressure, a predictor of mortality and life expectancy following heart failure hospitalization, 2010-2023

Authors

Mohammed Yousufuddin, Department of Hospital Internal Medicine, Mayo Clinic Health System, Austin, MN, USA. Electronic address: yousufuddin.mohammed@mayo.edu.
Zeliang Ma, Department of Hospital Internal Medicine, Mayo Clinic Health System, Austin, MN, USA.
Ebrahim Barkoudah, Department Hospital Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, and Baystate Health, Springfield, MA, USA.
Muhammad Waqas Tahir, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA.
Meltiady Issa, Department of Hospital Internal Medicine, Mayo Clinic, Rochester, MN, USA.
Zhen Wang, Department of Hospital Internal Medicine, Mayo Clinic, Jacksonville, FL, USA.
Fatmaelzahraa Badr, Department of Hospital Internal Medicine, Mayo Clinic Health System, Austin, MN, USA.
Ibrahim A. Gomaa, Department of Hospital Internal Medicine, Mayo Clinic Health System, Austin, MN, USA.
Sara Aboelmaaty, Department of Hospital Internal Medicine, Mayo Clinic Health System, Austin, MN, USA.
Ahmed A. Al-Anii, Department of Internal Medicine, Mayo Clinic Health System, Austin, MN, USA.
Sarah L. Gerard, Department of Hospital Internal Medicine, Mayo Clinic Health System, Austin, MN, USA.
Ahmed D. Abdalrhim, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA.
Sumit Bhagra, Department of Endocrine and Metabolism, Mayo Clinic Health System, Austin, MN, USA.
Arshad Jahangir, Advocate Health - MidwestFollow
Rehan Qayyum, Department of Medicine, Eastern Virginia Medical School, Norfolk, VA, USA.
Gregg C. Fonarow, Division of Cardiology, University of California Los Angeles, Los Angeles, CA, USA.
Mohamad H. Yamani, Department of Cardiovascular Medicine, Circulatory Failure, Mayo Clinic, Jacksonville, FL, USA.

Recommended Citation

Yousufuddin M, Ma Z, Barkoudah E, et al. Systolic blood pressure, a predictor of mortality and life expectancy following heart failure hospitalization, 2010-2023. Eur J Intern Med. Published online October 21, 2024. doi:10.1016/j.ejim.2024.10.004

Affiliations

Aurora St. Luke's Medical Center

Abstract

Background:Optimal systolic blood pressure (SBP) targets for the treatment of hospitalized acute decompensated heart failure (ADHF) patients are not known.

Objectives:To investigate the association between SBP <130 mmHg at discharge or within 30 days and all-cause mortality or years of life lost (YLL) after ADHF hospitalization.

Methods:We analyzed medical records of 14,611 adults who survived ADHF hospitalization at 17 hospitals (2010-2022) with follow-up until May 2023. Sensitivity analysis included 10,515 patients with post-discharge SBP measured within 30 days.

Results:Mortality rates at 30 days, 180 days, 1 year, and 3 years were higher in patients with discharge SBP <130 mmHg (6.9 %, 21.1 %, 29.1 %, and 45.1 %) vs. SBP ≥130 mmHg (4.8 %, 16.0 %, 23.6 %, and 40.3 %). Hazard ratios (HR) for mortality were consistently higher in patients with discharge SBP <130 at 1.30 (95 % CI, 1.11-1.52), 1.45 (95 % CI, 1.33-1.58), 1.40 (95 % CI, 1.30-1.51), 1.31 (95 % CI, 1.23-1.38) at these intervals. The average YLL per deceased individual was 1-2 years greater in the discharge SBP <130 group (incidence rate ratios, 1.004 to 1.230). Restricted cubic spline analysis showed that HR for mortality shifted toward better outcomes at discharge SBP ≥130 Sensitivity analysis supported these findings.

Conclusion:In hospitalized ADHF patients, SBP <130 mmHg at discharge or within 30 days post-discharge was linked to higher mortality and YLL, while SBP ≥130 mmHg or improvement to ≥130 mmHg post-discharge led to better short and long-term outcomes. Further research is needed to understand the mechanisms and benefits of SBP optimization.

Type

Article

PubMed ID

39438195