Published Online
on September 24, 2009

A more recent version of this article appeared on November 1, 2009

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Original Article

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

Douglas S. Lee^1,6; Nina Ghosh²; John S. Floras³; Gary E. Newton³; Peter C. Austin⁴; Xuesong Wang⁴; Peter P. Liu²; Thérèse A. Stukel⁴ and Jack V. Tu⁵

¹ Institute for Clinical Evaluative Sciences and University Health Network, Toronto, Ontario, Canada;
² University Health Network, Toronto, Ontario, Canada;
³ University of Toronto, Mount Sinai Hospital, Toronto, Ontario, Canada;
⁴ Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada;
⁵ Institute for Clinical Evaluative Sciences; Sunnybrook Health Sciences Ctr.,Toronto, Ontario, Canada

^* Corresponding author; email: dlee{at}ices.on.ca

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 heart failure patients (75.2±11.5 years; 49.9% men) discharged from hospital in Ontario, Canada, we examined the association of systolic 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; 0.71-0.98, p=0.029) when discharge systolic blood pressure was 100-119 mmHg, and decreased by 23% (survival time ratio 0.77, 95%CI; 0.62-0.97, p=0.024) when discharge systolic blood pressure was <100 mmHg, compared to those in the reference range of 120-139 mmHg. Survival time ratios were 0.75 (95%CI; 0.60-0.92, p=0.007) and 0.75 (95%CI; 0.53-1.07, p=0.12) when discharge systolic blood pressures were 140-159 and 160 mmHg, respectively. In those with left ventricular ejection fraction >40%, survival time ratios were 0.69 (95%CI; 0.51-0.93), 0.83 (95%CI; 0.71-0.99), 0.95 (95%CI; 0.80-1.14) and 0.76 (95%CI; 0.61-0.95) for discharge systolic blood pressures <100, 100-119, 140-159, and 160 mmHg, respectively.

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

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