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Original Articles

Association of Blood Pressure at Hospital Discharge With Mortality in Patients Diagnosed With Heart Failure

Douglas S. Lee, MD, PhD; Nina Ghosh, MD; John S. Floras, MD, DPhil; Gary E. Newton, MD; Peter C. Austin, PhD; Xuesong Wang, MSc; Peter P. Liu, MD; Thérèse A. Stukel, PhD and Jack V. Tu, MD, PhD

From the Institute for Clinical Evaluative Sciences (D.S.L., P.C.A., X.W., T.A.S., J.V.T.); Department of Medicine and Division of Cardiology (D.S.L., N.G., P.P.L.), University Health Network; Division of Cardiology, Mount Sinai Hospital (J.S.F., G.E.N.); Department of Health Policy, Management and Evaluation (T.A.S.) and Department of Medicine, Division of Cardiology (J.V.T.), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.

Correspondence to Douglas S. Lee, MD, PhD, FRCPC, Institute for Clinical Evaluative Sciences, Room G-106, 2075 Bayview Ave, Toronto, Ontario, M4N 3M5 Canada. E-mail dlee{at}ices.on.ca

Received March 31, 2009; accepted August 27, 2009.

Background— Higher blood pressure in acute heart failure has been associated with improved survival; however, the relationship between blood pressure and survival in stabilized patients at hospital discharge has not been established.

Methods and Results— In 7448 patients with heart failure (75.2±11.5 years; 49.9% men) discharged from the hospital in Ontario, Canada, we examined the association of systolic blood pressure (SBP) and diastolic blood pressure with long-term survival. Parametric survival analysis was performed, and survival time ratios were determined according to discharge blood pressure group. A total of 25 427 person-years of follow-up were examined. In those with left ventricular ejection fraction 40%, median survival was decreased by 17% (survival time ratio, 0.83; 95% CI, 0.71 to 0.98; P=0.029) when discharge SBP was 100 to 119 mm Hg and decreased by 23% (survival time ratio, 0.77; 95% CI, 0.62 to 0.97; P=0.024) when discharge SBP was <100 mm Hg, compared with those in the reference range of 120 to 139 mm Hg. Survival time ratios were 0.75 (95% CI, 0.60 to 0.92; P=0.007) and 0.75 (95% CI, 0.53 to 1.07; P=0.12) when discharge SBPs were 140 to 159 and 160 mm Hg, respectively. In those with left ventricular ejection fraction >40%, survival time ratios were 0.69 (95% CI, 0.51 to 0.93), 0.83 (95% CI, 0.71 to 0.99), 0.95 (95% CI, 0.80 to 1.14), and 0.76 (95% CI, 0.61 to 0.95) for discharge SBPs <100, 100 to 119, 140 to 159, and 160 mm Hg, respectively.

Conclusions— In this long-term population-based study of patients with heart failure, the association of discharge SBP with mortality followed a U-shaped distribution. Survival was shortened in those with reduced or increased values of discharge SBP.

Key Words: heart failure • blood pressure • hypertension • mortality • health outcomes

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