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. 2010 Jul 15;106(2):221-7.
doi: 10.1016/j.amjcard.2010.02.032.

Impact of baseline systolic blood pressure on long-term outcomes in patients with advanced chronic systolic heart failure (insights from the BEST trial)

Ravi V Desai  1 , Maciej Banach, Mustafa I Ahmed, Marjan Mujib, Inmaculada Aban, Thomas E Love, Michel White, Gregg Fonarow, Prakash Deedwania, Wilbert S Aronow, Ali Ahmed
Affiliations

Impact of baseline systolic blood pressure on long-term outcomes in patients with advanced chronic systolic heart failure (insights from the BEST trial)

Ravi V Desai et al. Am J Cardiol. .

Abstract

The impact of baseline systolic blood pressure (SBP) on outcomes in patients with advanced chronic systolic heart failure (HF) has not been studied using a propensity-matched design. Of the 2,706 participants in the Beta-Blocker Evaluation of Survival Trial (BEST) with chronic HF, New York Heart Association class III to IV symptoms and left ventricular ejection fraction < or =35%, 1,751 had SBP < or =120 mm Hg (median 108, range 70 to 120) and 955 had SBP >120 mm Hg (median 134, range 121 to 192). Propensity scores for SBP >120 mm Hg, calculated for each patient, were used to assemble a matched cohort of 545 pairs of patients with SBPs < or =120 and >120 mm Hg who were balanced in 65 baseline characteristics. Matched Cox regression models were used to estimate associations between SBP < or =120 mm Hg and outcomes over 4 years of follow-up. Matched participants had a mean age +/- SD of 62 +/- 12 years, 24% were women, and 24% were African-American. HF hospitalization occurred in 38% and 32% of patients with SBPs < or =120 and >120 mm Hg, respectively (hazard ratio 1.33 SBP < or =120 was compared to >120 mm Hg, 95% confidence interval 1.04 to 1.69, p = 0.023). All-cause mortality occurred in 28% and 30% of matched patients with SBPs < or =120 and >120 mm Hg, respectively (hazard ratio 1.13 SBP < or =120 compared to >120 mm Hg, 95% confidence interval 0.86 to 1.49, p = 0.369). In conclusion, in patients with advanced chronic systolic HF, baseline SBP < or =120 mm Hg is associated with increased risk of HF hospitalization, but had no association with all-cause mortality.

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Conflict of interest statement

Conflict of Interest Disclosures: None

Figures

Figure 1
Figure 1
Absolute standardized differences comparing covariate values for patients with systolic BP >120 and ≤120 mm Hg, before and after propensity score matching (ACE=angiotensin-converting enzyme; ARB=angiotensin-receptor blocker; NYHA=New York Heart Association)
Figure 2
Figure 2
Kaplan-Meier plots of (a) all-cause mortality and (b) heart failure (HF) hospitalization by systolic blood pressure (SBP) (CI=confidence interval; HR=hazard ratio)
Figure 3
Figure 3
Association of systolic blood pressure (SBP) ≤120 mm Hg and heart failure (HF) hospitalization in subgroups of HF patients (CI=confidence interval; HR=hazard ratio)
See this image and copyright information in PMC

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