In people with chronic heart failure, are large blood pressure changes linked to worse survival?

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Chronic heart failure (CHF) is the final stage of many heart diseases. Identifying important risk factors for adverse clinical events in people with CHF is needed to improve outcomes. This study aimed to examine how long-term blood pressure (BP) changes relate to prognosis and mortality in a real-world cohort of CHF patients.

This was a retrospective longitudinal analysis. Repeated office BP measurements were scheduled at follow-up visits every 3–6 months. The primary endpoint was time to death or heart transplantation (HTx). Cox regression with time-dependent strata was used to analyse the relationship of systolic blood pressure (SBP) values and their changes during follow-up with this endpoint.

The study included 927 patients, with a median survival of 7.7 years (95% confidence interval [CI] 6.6–9.8). During follow-up, 220 patients died and 70 underwent HTx. The BP stratum with the most stable values had the best survival. Annual BP increases greater than 10 mmHg and decreases greater than 10 mmHg were associated with significantly worse outcomes, with hazard ratios (HRs) of 1.8 and 2.0, respectively.

The stratum with the lowest SBP levels, below 90 mmHg, had the highest mortality. Multiple regression analysis reported an HR of 17 (95% CI 9.7–29) for this stratum compared with the stratum with SBP of at least 130 mmHg.

The authors concluded that low SBP (below 90 mmHg) and pronounced long-term SBP changes were associated with poor survival in patients with CHF. They called for additional prospective studies to further define optimal BP targets in these patients.