This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (108)  • Contact me when this article is cited  Related Content  • Related letters  • Related articles  • Similar articles in JAMA  Topic Collections  • Cardiovascular System  • Prognosis/ Outcomes  • Cardiovascular Disease/ Myocardial Infarction  • Hypertension  • Alert me on articles by topic  Social Bookmarking   What's this?

Mihai Gheorghiade, MD; William T. Abraham, MD; Nancy M. Albert, RN, PhD; Barry H. Greenberg, MD; Christopher M. O’Connor, MD; Lilin She, PhD; Wendy Gattis Stough, PharmD; Clyde W. Yancy, MD; James B. Young, MD; Gregg C. Fonarow, MD; for the OPTIMIZE-HF Investigators and Coordinators

JAMA. 2006;296:2217-2226.

Context  The association between systolic blood pressure (SBP) at admission, clinical characteristics, and outcomes in patients hospitalized for heart failure who have reduced or relatively preserved systolic function has not been well studied.

Objective  To evaluate the relationship between SBP at admission, clinical profile, and outcomes in patients hospitalized for acute heart failure.

Design, Setting, and Patients  Cohort study using data from the Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure (OPTIMIZE-HF) registry and performance-improvement program for patients hospitalized with heart failure at 259 US hospitals between March 2003 and December 2004. Patients were divided into quartiles by SBP at hospital admission (<120, 120-139, 140-161, and >161 mm Hg). In-hospital outcomes were based on 48 612 patients aged 18 years or older with heart failure. Of the 41 267 patients with left ventricular function assessed, 21 149 (51%) had preserved left ventricular function. Postdischarge outcomes were based on a prespecified subgroup (n = 5791, 10% of patients) with follow-up data assessed between 60 and 90 days.

Main Outcome Measures  In-hospital and postdischarge mortality.

Results  Patients with higher SBP were more likely to be female and black and to have preserved systolic function. Fifty percent of the patients had SBP higher than 140 mm Hg at admission. Patients with lower SBP at admission had higher in-hospital and postdischarge mortality rates. Higher SBP at admission was associated with lower in-hospital mortality rates: 7.2% (<120 mm Hg), 3.6% (120-139 mm Hg), 2.5% (140-161 mm Hg), and 1.7% (>161 mm Hg) (P<.001 for overall difference). Postdischarge mortality rates in the follow-up cohort by SBP at admission were 14.0%, 8.4%, 6.0%, and 5.4%, respectively (P<.001 for overall difference).

Conclusions  Systolic hypertension is common in patients hospitalized for heart failure. Systolic blood pressure is an independent predictor of morbidity and mortality in patients with heart failure with either reduced or relatively preserved systolic function. Low SBP (<120 mm Hg) at hospital admission identifies patients who have a poor prognosis despite medical therapy. These findings may have important therapeutic implications because characteristics and outcomes differ greatly among patients with heart failure with varying SBP.

Author Affiliations: Division of Cardiology, Feinberg School of Medicine, Northwestern University, Chicago, Ill (Dr Gheorghiade); Division of Cardiology, Ohio State University, Columbus (Dr Abraham); George M. and Linda H. Kaufman Center for Heart Failure, Cleveland Clinic Foundation, Cleveland, Ohio (Drs Albert and Young); Department of Medicine, University of California San Diego Medical Center, San Diego (Dr Greenberg); Duke Clinical Research Institute, Durham, NC (Drs O’Connor and She); Department of Medicine, Duke University Medical Center, Durham, NC (Dr Stough); Campbell University School of Pharmacy, Research Triangle Park, NC (Dr Stough); Department of Medicine, University of Texas Southwestern Medical Center, Dallas (Dr Yancy); and Department of Medicine, University of California Los Angeles Medical Center, Los Angeles (Dr Fonarow). Dr Yancy is now with the Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, Tex.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

RELATED LETTERS

Systolic Blood Pressure and Outcomes in Patients Hospitalized With Acute Heart Failure
Dae Hyun Kim and Hyunseok Kang
JAMA. 2007;297(8):807-808.
EXTRACT | FULL TEXT  

Systolic Blood Pressure and Outcomes in Patients Hospitalized With Acute Heart Failure—Reply
Mihai Gheorghiade and Gregg C. Fonarow
JAMA. 2007;297(8):808-809.
EXTRACT | FULL TEXT  

RELATED ARTICLES

Systolic and Diastolic Heart Failure in the Community
Francesca Bursi, Susan A. Weston, Margaret M. Redfield, Steven J. Jacobsen, Serguei Pakhomov, Vuyisile T. Nkomo, Ryan A. Meverden, and Véronique L. Roger
JAMA. 2006;296(18):2209-2216.
ABSTRACT | FULL TEXT  

Systolic and Nonsystolic Heart Failure: Equally Serious Threats
Per Hildebrandt
JAMA. 2006;296(18):2259-2260.
EXTRACT | FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Association of Blood Pressure at Hospital Discharge With Mortality in Patients Diagnosed With Heart Failure
Lee et al.
Circ Heart Fail 2009;2:616-623.
ABSTRACT | FULL TEXT  

Factors Associated With Neurologically Intact Survival for Patients With Acute Heart Failure and In-Hospital Cardiac Arrest
Levy et al.
Circ Heart Fail 2009;2:572-581.
ABSTRACT | FULL TEXT  

Reduced in-hospital mortality for heart failure with clinical pathways: the results of a cluster randomised controlled trial
Panella et al.
Qual Saf Health Care 2009;18:369-373.
ABSTRACT | FULL TEXT  

A human atrial natriuretic peptide gene mutation reveals a novel peptide with enhanced blood pressure-lowering, renal-enhancing, and aldosterone-suppressing actions.
McKie et al.
J Am Coll Cardiol 2009;54:1024-1032.
ABSTRACT | FULL TEXT  

Weight changes after hospitalization for worsening heart failure and subsequent re-hospitalization and mortality in the EVEREST trial
Blair et al.
Eur Heart J 2009;30:1666-1673.
ABSTRACT | FULL TEXT  

Importance of Treadmill Exercise Time as an Initial Prognostic Screening Tool in Patients With Systolic Left Ventricular Dysfunction
Hsich et al.
Circulation 2009;119:3189-3197.
ABSTRACT | FULL TEXT  

Are BNP Changes During Hospitalization for Heart Failure a Reliable Surrogate for Predicting the Effects of Therapies on Post-Discharge Mortality?
Gheorghiade and Pang
J Am Coll Cardiol 2009;53:2349-2352.
FULL TEXT  

Low-dose nitroglycerin improves microcirculation in hospitalized patients with acute heart failure
den Uil et al.
Eur J Heart Fail 2009;11:386-390.
ABSTRACT | FULL TEXT  

Acute heart failure syndromes.
Gheorghiade and Pang
J Am Coll Cardiol 2009;53:557-573.
ABSTRACT | FULL TEXT  

Acute heart failure syndromes in patients with coronary artery disease early assessment and treatment.
Flaherty et al.
J Am Coll Cardiol 2009;53:254-263.
ABSTRACT | FULL TEXT  

Clinical effectiveness of beta-blockers in heart failure: findings from the OPTIMIZE-HF (Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure) Registry.
Hernandez et al.
J Am Coll Cardiol 2009;53:184-192.
ABSTRACT | FULL TEXT  

Is a higher blood pressure better in heart failure?
Thohan and Little
Heart 2009;95:4-5.
FULL TEXT  

Quantifying the paradoxical effect of higher systolic blood pressure on mortality in chronic heart failure
Raphael et al.
Heart 2009;95:56-62.
ABSTRACT | FULL TEXT  

Clinical Outcomes According to Baseline Blood Pressure in Patients With a Low Ejection Fraction in the CHARM (Candesartan in Heart failure: Assessment of Reduction in Mortality and morbidity) Program
Meredith et al.
J Am Coll Cardiol 2008;52:2000-2007.
ABSTRACT | FULL TEXT  

Influence of coronary artery disease and coronary revascularization status on outcomes in patients with acute heart failure syndromes: A report from OPTIMIZE-HF (Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure)
Rossi et al.
Eur J Heart Fail 2008;10:1215-1223.
ABSTRACT | FULL TEXT  

Continental Differences in Clinical Characteristics, Management, and Outcomes in Patients Hospitalized With Worsening Heart Failure: Results From the EVEREST (Efficacy of Vasopressin Antagonism in Heart Failure: Outcome Study with Tolvaptan) Program
Blair et al.
J Am Coll Cardiol 2008;52:1640-1648.
ABSTRACT | FULL TEXT  

Measuring Quality in Heart Failure: Do We Have the Metrics?
Bonow
Circ Cardiovasc Qual Outcomes 2008;1:9-11.
FULL TEXT  

A smoker's paradox in patients hospitalized for heart failure: findings from OPTIMIZE-HF
Fonarow et al.
Eur Heart J 2008;29:1983-1991.
ABSTRACT | FULL TEXT  

Predictors of In-Hospital Mortality in Patients Hospitalized for Heart Failure: Insights From the Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients With Heart Failure (OPTIMIZE-HF)
Abraham et al.
J Am Coll Cardiol 2008;52:347-356.
ABSTRACT | FULL TEXT  

Influence of Beta-Blocker Continuation or Withdrawal on Outcomes in Patients Hospitalized With Heart Failure Findings From the OPTIMIZE-HF Program.
Fonarow et al.
J Am Coll Cardiol 2008;52:190-199.
ABSTRACT | FULL TEXT  

Sodium nitroprusside for advanced low-output heart failure.
Mullens et al.
J Am Coll Cardiol 2008;52:200-207.
ABSTRACT | FULL TEXT  

Noninvasive Ventilation in Acute Cardiogenic Pulmonary Edema
Gray et al.
NEJM 2008;359:142-151.
ABSTRACT | FULL TEXT  

Acute heart failure syndromes and coronary perfusion.
Beohar et al.
J Am Coll Cardiol 2008;52:13-16.
ABSTRACT | FULL TEXT  

Heart Failure Care in the Outpatient Cardiology Practice Setting: Findings From IMPROVE HF
Fonarow et al.
Circ Heart Fail 2008;1:98-106.
ABSTRACT | FULL TEXT  

Hemodynamic, Echocardiographic, and Neurohormonal Effects of Istaroxime, a Novel Intravenous Inotropic and Lusitropic Agent: A Randomized Controlled Trial in Patients Hospitalized With Heart Failure
Gheorghiade et al.
J Am Coll Cardiol 2008;51:2276-2285.
ABSTRACT | FULL TEXT  

The Year in Hypertension
Williams
J Am Coll Cardiol 2008;51:1803-1817.
FULL TEXT  

Effect of Baseline and Changes in Systolic Blood Pressure Over Time on the Effectiveness of Valsartan in the Valsartan Heart Failure Trial
Anand et al.
Circ Heart Fail 2008;1:34-42.
ABSTRACT | FULL TEXT  

Day of Admission and Clinical Outcomes for Patients Hospitalized for Heart Failure: Findings From the Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients With Heart Failure (OPTIMIZE-HF)
Fonarow et al.
Circ Heart Fail 2008;1:50-57.
ABSTRACT | FULL TEXT  

Quality of Care of and Outcomes for African Americans Hospitalized With Heart Failure: Findings From the OPTIMIZE-HF (Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients With Heart Failure) Registry
Yancy et al.
J Am Coll Cardiol 2008;51:1675-1684.
ABSTRACT | FULL TEXT  

Factors Identified as Precipitating Hospital Admissions for Heart Failure and Clinical Outcomes: Findings From OPTIMIZE-HF
Fonarow et al.
Arch Intern Med 2008;168:847-854.
ABSTRACT | FULL TEXT  

A proposal to standardize dyspnoea measurement in clinical trials of acute heart failure syndromes: the need for a uniform approach
Pang et al.
Eur Heart J 2008;29:816-824.
ABSTRACT | FULL TEXT  

Fluid overload in acute heart failure -- Re-distribution and other mechanisms beyond fluid accumulation
Cotter et al.
Eur J Heart Fail 2008;10:165-169.
ABSTRACT | FULL TEXT  

Worsening renal function in patients hospitalised for acute heart failure: Clinical implications and prognostic significance
Metra et al.
Eur J Heart Fail 2008;10:188-195.
ABSTRACT | FULL TEXT  

Overview of emerging pharmacologic agents for acute heart failure syndromes
De Luca et al.
Eur J Heart Fail 2008;10:201-213.
ABSTRACT | FULL TEXT  

Progressive Diastolic Dysfunction in the Female mRen(2).Lewis Rat: Influence of Salt and Ovarian Hormones
Groban et al.
Journals of Gerontology Series A: Biological Sciences and Medical Sciences 2008;63:3-11.
ABSTRACT | FULL TEXT  

Characterization and Prognostic Value of Persistent Hyponatremia in Patients With Severe Heart Failure in the ESCAPE Trial
Gheorghiade et al.
Arch Intern Med 2007;167:1998-2005.
ABSTRACT | FULL TEXT  

Characteristics, Treatments, and Outcomes of Patients With Preserved Systolic Function Hospitalized for Heart Failure: A Report From the OPTIMIZE-HF Registry
Fonarow et al.
J Am Coll Cardiol 2007;50:768-777.
ABSTRACT | FULL TEXT  

Influence of a Performance-Improvement Initiative on Quality of Care for Patients Hospitalized With Heart Failure: Results of the Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients With Heart Failure (OPTIMIZE-HF)
Fonarow et al.
Arch Intern Med 2007;167:1493-1502.
ABSTRACT | FULL TEXT  

Relationship between admission serum sodium concentration and clinical outcomes in patients hospitalized for heart failure: an analysis from the OPTIMIZE-HF registry
Gheorghiade et al.
Eur Heart J 2007;28:980-988.
ABSTRACT | FULL TEXT  

Short-term Clinical Effects of Tolvaptan, an Oral Vasopressin Antagonist, in Patients Hospitalized for Heart Failure: The EVEREST Clinical Status Trials
Gheorghiade et al.
JAMA 2007;297:1332-1343.
ABSTRACT | FULL TEXT  

JournalScan
Lindsay
Heart 2007;93:409-410.
FULL TEXT  

Systolic Blood Pressure and Outcomes in Patients Hospitalized With Acute Heart Failure
Kim and Kang
JAMA 2007;297:807-808.
FULL TEXT  

Association Between Performance Measures and Clinical Outcomes for Patients Hospitalized With Heart Failure
Fonarow et al.
JAMA 2007;297:61-70.
ABSTRACT | FULL TEXT  

Low systolic blood pressure signals a high risk of death in people with acute heart failure
BMJ 2006;333:1064-1064.
FULL TEXT  

Systolic and nonsystolic heart failure: equally serious threats.
Hildebrandt
JAMA 2006;296:2259-2260.
FULL TEXT  

HF with Preserved LV Systolic Function: A Call to Action
Journal Watch Cardiology 2006;2006:1-1.
FULL TEXT