Abstract 2940: Higher Systolic Blood Pressure is Associated with Improved Survival in Both Ischemic and Non-Ischemic Systolic Heart Failure Independent of Invasive Hemodynamics and Medical Therapy
Higher systolic blood pressure (SBP) is a predictor of survival for patients with heart failure (HF). Whether SBP predicts survival in both ischemic and non-ischemic HF has not been well examined. 2178 patients with advanced HF (47.3% ischemic etiology, 75.5% male, 93.5% NYHA class III or IV, age 52 ± 13, left ventricular ejection fraction [LVEF] 24% ± 9%) referred to a university center between 1983 and 2006 were analyzed. SBP and invasive hemodynamic variables were recorded after optimization of medical therapy. Patients were divided into SBP quartiles (≤ 90, 91–100, 101–112, ≥ 113 mm Hg) based on SBP frequency. 1148 patients had non-ischemic HF and 1030 had ischemic HF. Non-ischemic HF were younger and more likely to be female. Non-ischemic and ischemic HF patients were similar in terms of NYHA class, LVEF, and BNP levels. Survival free from death or urgent transplant in ischemic versus non-ischemic HF was 53.2% versus 61.1% at 2 years. Higher SBP quartile was associated with increased survival in the total cohort and in subgroups of both non-ischemic and ischemic HF. On multivariate analysis adjusting for age, LVEF, cholesterol, gender, diabetes, PCWP, cardiac index, NYHA class, beta-blocker use, ACE-I or ARB use, statin use, and smoking history, relative risk (95% CI) of death or urgent transplant at 2 years for quartile 1 compared to quartile 4 was 1.9 (1.4 – 2.6) in the total cohort, 1.6 (1.1 – 2.5) in non-ischemic HF, and 2.4 (1.5 – 3.7) in ischemic HF (table⇓). SBP predicts HF survival in both ischemic and non-ischemic HF independent of other risk factors and invasive hemodynamic variables. Further investigation is needed to determine the optimal SBP goals in HF patients on medical therapy.