Researchers link pulse pressure to adverse outcomes in heart failure patients

As pulse pressure increased, rates of all-cause mortality increased among heart failure patients with both reduced ejection fraction and preserved ejection fraction.
As pulse pressure increased, rates of all-cause mortality increased among heart failure patients with both reduced ejection fraction and preserved ejection fraction.

As pulse pressure increased, rates of 1-year all-cause mortality and a composite of 1-year all-cause mortality and readmission also increased among heart failure (HF) patients with reduced ejection fraction (HFrEF) and preserved ejection fraction (HFpEF).

Although pulse pressure has been associated with HF development, its value and utility in patients with prevalent HF remains unknown, which led researchers to examine the relationship between pulse pressure and adverse 1-year outcomes in patients hospitalized for HF.

The retrospective cohort study included clinical registry data linked to Medicare claims for 40 421 patients with HF who entered the Get With the Guidelines-Heart Failure program.

One-year all-cause mortality served as the primary outcome measure, and 1-year all-cause mortality or readmission served as the secondary outcome.

In patients with HFrEF (<0.4), there was a nonlinear relationship between pulse pressure and mortality, with risk decreasing as pulse pressure increased up to 50 mm Hg (adjusted hazard ratio [HR] per 10 mm Hg increase=0.946; P=.03). Conversely, when pulse pressure was ≥50 mm Hg, mortality risk increased as pulse pressure increased (adjusted HR=1.091; 95% confidence interval [CI]; P<.0001).

“Of note, the reported HRs are adjusted for the use of evidence-based pharmacologic therapy at the time of discharge and includes beta-blockers, angiotensin converting enzyme inhibitors or angiotensin receptor blockers as well as the patient's pre-existent anti-hypertensive therapy,” the researchers wrote.

When pulse pressure increased among patients with HFpEF (>0.4), so too did risk for mortality; however, the risk magnitude was influenced by systolic blood pressure.

Results were similar for the secondary endpoint and when using an ejection fraction of >0.5 to define HFpEF, the researchers reported.

“Arterial pulse pressure, a function of both ventricular output and arterial stiffness, in patients with heart failure is associated with all-cause mortality and the composite of all cause-mortality or readmission at 1 year in patients with either HFrEF or HFpEF,” the researchers concluded. “The magnitude of association is strongly affected by the systolic blood pressure in HFpEF.”

They added that further studies examining the impact of targeted pulse pressure modification or measures of aortic stiffness in patients with HF may provide a better understanding of ventricular-arterial interactions in those patients.

Reference

  1. Laskey WK, Wu J, Schulte PJ, et al. The association of arterial pulse pressure with long-term clinical outcomes in patients with heart failure. JACC Heart Fail. 2015. doi:10.1016/j.jchf.2015.09.012
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