TY - JOUR
T1 - Association of systolic blood pressure with mortality in patients with heart failure with reduced ejection fraction
T2 - A complex relationship
AU - Ather, Sameer
AU - Chan, Wenyaw
AU - Chillar, Annirudha
AU - Aguilar, David
AU - Pritchett, Allison M.
AU - Ramasubbu, Kumudha
AU - Wehrens, Xander H.T.
AU - Deswal, Anita
AU - Bozkurt, Biykem
N1 - Funding Information:
D.A. is a recipient of a NIH Mentored Career Development Award (5K01-HL092585-02). X.H.T.W. is a W.M. Keck Foundation Distinguished Young Scholar in Medical Research, and is also supported by NIH/NHLBI grants R01-HL089598 and R01HL091947 . DA is supported by VA Health Services Research and Development Service grant IIR02-082-1. B.B. is supported by NIH 3U01DE017793 and 9K30RR02229. The authors are solely responsible for the design and conduct of this study, all study analyses, the drafting and editing of the paper and its final contents.
PY - 2011/3/3
Y1 - 2011/3/3
N2 - Background: In ambulatory patients with heart failure with reduced ejection fraction (HFrEF), high systolic blood pressure (SBP) is associated with better outcomes. However, it is not known whether there is a ceiling beyond which high SBP has a detrimental effect. Thus, our aim was to assess the linearity of association between SBP and mortality. Methods: We used the External Peer Review Program (EPRP) and Digitalis Investigation Group (DIG) trial databases of HFrEF patients. Linearity of association of SBP with mortality was assessed by plotting Martingale residuals against SBP. To assess the patterns of relationship of SBP with mortality, we used restricted cubic spline analysis with Cox proportional hazards model. Results: In patients with mild-to-moderate left ventricular systolic dysfunction (LVSD) (30% ≤ LVEF < 50%), SBP had a nonlinear association with mortality in both EPRP (n = 3,693) and DIG (n = 3,263) databases. In these patients, SBP had a significant U-shaped association with mortality in EPRP and a trend toward U-shaped relationship in DIG database. In patients with severe LVSD (LVEF <30%), SBP had a linear association with mortality in both EPRP (n = 2,906) and DIG (n = 3,537) databases, with lower SBP being associated with increased mortality. Conclusions: Systolic blood pressure has a complex nonlinear association with mortality in patients with heart failure. Whereas it has a U-shaped association in patients with mild-to-moderate LVSD, it has a linear association with mortality in patients with severe LVSD. Recognition of this pattern of association of blood pressure profile may help clinicians in providing better care for their patients and help improve existing prediction models.
AB - Background: In ambulatory patients with heart failure with reduced ejection fraction (HFrEF), high systolic blood pressure (SBP) is associated with better outcomes. However, it is not known whether there is a ceiling beyond which high SBP has a detrimental effect. Thus, our aim was to assess the linearity of association between SBP and mortality. Methods: We used the External Peer Review Program (EPRP) and Digitalis Investigation Group (DIG) trial databases of HFrEF patients. Linearity of association of SBP with mortality was assessed by plotting Martingale residuals against SBP. To assess the patterns of relationship of SBP with mortality, we used restricted cubic spline analysis with Cox proportional hazards model. Results: In patients with mild-to-moderate left ventricular systolic dysfunction (LVSD) (30% ≤ LVEF < 50%), SBP had a nonlinear association with mortality in both EPRP (n = 3,693) and DIG (n = 3,263) databases. In these patients, SBP had a significant U-shaped association with mortality in EPRP and a trend toward U-shaped relationship in DIG database. In patients with severe LVSD (LVEF <30%), SBP had a linear association with mortality in both EPRP (n = 2,906) and DIG (n = 3,537) databases, with lower SBP being associated with increased mortality. Conclusions: Systolic blood pressure has a complex nonlinear association with mortality in patients with heart failure. Whereas it has a U-shaped association in patients with mild-to-moderate LVSD, it has a linear association with mortality in patients with severe LVSD. Recognition of this pattern of association of blood pressure profile may help clinicians in providing better care for their patients and help improve existing prediction models.
KW - COPD
KW - DBP
KW - DIG
KW - Digitalis Investigation Group
KW - EPRP
KW - External Peer Review Program
KW - HFrEF
KW - HR
KW - LVEF
KW - LVSD
KW - PH
KW - SBP
KW - chronic obstructive pulmonary disease
KW - diastolic blood pressure
KW - hazard ratio
KW - heart Failure with reduced ejection fraction
KW - left ventricular ejection fraction
KW - left ventricular systolic dysfunction
KW - proportional hazards
KW - systolic blood pressure
UR - http://www.scopus.com/inward/record.url?scp=79952397743&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=79952397743&partnerID=8YFLogxK
U2 - 10.1016/j.ahj.2010.12.009
DO - 10.1016/j.ahj.2010.12.009
M3 - Article
C2 - 21392613
AN - SCOPUS:79952397743
SN - 0002-8703
VL - 161
SP - 567
EP - 573
JO - American Heart Journal
JF - American Heart Journal
IS - 3
ER -