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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.

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RELATED LETTERS

Systolic Blood Pressure and Outcomes in Patients Hospitalized With Acute Heart Failure
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JAMA. 2007;297(8):808-809.
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