Systolic blood pressure, a predictor of mortality and life expectancy following heart failure hospitalization, 2010-2023

Mohammed Yousufuddin; Zeliang Ma; Ebrahim Barkoudah; Muhammad Waqas Tahir; Meltiady Issa; Zhen Wang; Fatmaelzahraa Badr; Ibrahim A Gomaa; Sara Aboelmaaty; Ahmed A Al-Anii; Sarah L Gerard; Ahmed D Abdalrhim; Sumit Bhagra; Arshad Jahangir; Rehan Qayyum; Gregg C Fonarow; Mohamad H Yamani

doi:10.1016/j.ejim.2024.10.004

Systolic blood pressure, a predictor of mortality and life expectancy following heart failure hospitalization, 2010-2023

Eur J Intern Med. 2024 Oct 21:S0953-6205(24)00415-1. doi: 10.1016/j.ejim.2024.10.004. Online ahead of print.

Authors

Mohammed Yousufuddin¹, Zeliang Ma², Ebrahim Barkoudah³, Muhammad Waqas Tahir⁴, Meltiady Issa⁵, Zhen Wang⁶, Fatmaelzahraa Badr², Ibrahim A Gomaa², Sara Aboelmaaty², Ahmed A Al-Anii⁷, Sarah L Gerard², Ahmed D Abdalrhim⁸, Sumit Bhagra⁹, Arshad Jahangir¹⁰, Rehan Qayyum¹¹, Gregg C Fonarow¹², Mohamad H Yamani¹³

Affiliations

¹ Department of Hospital Internal Medicine, Mayo Clinic Health System, Austin, MN, USA. Electronic address: yousufuddin.mohammed@mayo.edu.
² Department of Hospital Internal Medicine, Mayo Clinic Health System, Austin, MN, USA.
³ Department Hospital Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, and Baystate Health, Springfield, MA, USA.
⁴ Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA.
⁵ Department of Hospital Internal Medicine, Mayo Clinic, Rochester, MN, USA.
⁶ Department of Hospital Internal Medicine, Mayo Clinic, Jacksonville, FL, USA.
⁷ Department of Internal Medicine, Mayo Clinic Health System, Austin, MN, USA.
⁸ Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA.
⁹ Department of Endocrine and Metabolism, Mayo Clinic Health System, Austin, MN, USA.
¹⁰ Aurora Cardiovascular and Thoracic Services, Aurora St. Luke Medical Center, Milwaukee, WI, USA.
¹¹ Department of Medicine, Eastern Virginia Medical School, Norfolk, VA, USA.
¹² Division of Cardiology, University of California Los Angeles, Los Angeles, CA, USA.
¹³ Department of Cardiovascular Medicine, Circulatory Failure, Mayo Clinic, Jacksonville, FL, USA.

PMID: 39438195
DOI: 10.1016/j.ejim.2024.10.004

Abstract

Background: Optimal systolic blood pressure (SBP) targets for the treatment of hospitalized acute decompensated heart failure (ADHF) patients are not known.

Objectives: To investigate the association between SBP <130 mmHg at discharge or within 30 days and all-cause mortality or years of life lost (YLL) after ADHF hospitalization.

Methods: We analyzed medical records of 14,611 adults who survived ADHF hospitalization at 17 hospitals (2010-2022) with follow-up until May 2023. Sensitivity analysis included 10,515 patients with post-discharge SBP measured within 30 days.

Results: Mortality rates at 30 days, 180 days, 1 year, and 3 years were higher in patients with discharge SBP <130 mmHg (6.9 %, 21.1 %, 29.1 %, and 45.1 %) vs. SBP ≥130 mmHg (4.8 %, 16.0 %, 23.6 %, and 40.3 %). Hazard ratios (HR) for mortality were consistently higher in patients with discharge SBP <130 at 1.30 (95 % CI, 1.11-1.52), 1.45 (95 % CI, 1.33-1.58), 1.40 (95 % CI, 1.30-1.51), 1.31 (95 % CI, 1.23-1.38) at these intervals. The average YLL per deceased individual was 1-2 years greater in the discharge SBP <130 group (incidence rate ratios, 1.004 to 1.230). Restricted cubic spline analysis showed that HR for mortality shifted toward better outcomes at discharge SBP ≥130 Sensitivity analysis supported these findings.

Conclusion: In hospitalized ADHF patients, SBP <130 mmHg at discharge or within 30 days post-discharge was linked to higher mortality and YLL, while SBP ≥130 mmHg or improvement to ≥130 mmHg post-discharge led to better short and long-term outcomes. Further research is needed to understand the mechanisms and benefits of SBP optimization.

Keywords: And years of life lost; Heart failure; Mortality; Systolic blood pressure.