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Different prognostic association of systolic blood pressure at different time points with postdischarge events in patients hospitalized for decompensated heart failure

查看全文 作　　者：You-Nan [1]YAO;Rong-Cheng [1]ZHANG;Tao [1]AN;Qi [1]ZHANG;Xin-Ke [2]ZHAO;Jian [2]ZHANG 高影响力作者 机构地区：[1]State Key Laboratory of Cardiovascular Disease, Heart Failure Care Unit of Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China;[2]The Affiliated Hospital of Gansu University of Chinese Medicine, Lanzhou, China高影响力机构 出　　处：《Journal of Geriatric Cardiology》索引2019年第16卷第9期,共17页高影响力期刊 基　　金：supported by a grant for Jian Zhang from the Key Projects in the National Science and Technology Pillar Program of the 13th Five-Year Plan Period (No. 2017YFC1308300), Beijing, China 摘　　要：Background The association of systolic blood pressure(SBP) with mortality in heart failure(HF) patients is paradoxical, and the time points of baseline SBP are also different across prior studies. We hypothesized that the levels of SBP at admission and at discharge had different associations with postdischarge events. Methods The study population included patients hospitalized for decompensated HF in the Heart Failure Center of Fuwai Hospital from January 1, 2009 to December 31, 2014. The primary outcome was a composite of cardiovascular(CV) death and heart transplantation. Multivariate Cox proportional-hazards and restricted cubic spline analyses were used to assess the relationships between SBP at different time points and outcomes. Results In total, 2005 patients were included with a median follow-up of 48.4 months. The median age was 59 years, and 69.9% were male. Multivariate Cox analyses showed that compared with SBP < 105 mm Hg, higher SBP at admission was associated with better long-term primary outcome(105–119 mm Hg, HR = 0.764, P = 0.005;120-134 mm Hg, HR = 0.658, P < 0.001;≥ 135 mm Hg, HR = 0.657, P = 0.001). Patients whose discharge SBP was higher than 135 mm Hg had a similar primary outcome as those with SBP < 105 mm Hg(HR = 0.969, P = 0.867), and the results remained unchanged even after adjusting for admission SBP(HR = 1.235, P = 0.291). The results of restricted cubic spline analysis indicated similar associations. Conclusions Lower but not higher SBP at admission is associated with more CV deaths/heart transplantations(a reverse J-shaped curve). In contrast, there is a U-shaped association between discharge SBP and CV mortality/heart transplantation. 关 键 词：ADMISSION Discharge Heart failure OUTCOME SYSTOLIC blood pressure
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