Abstract 1074: A Propensity Matched Analysis of Prognostic Implications of Systolic Blood Pressure in Patients With Stable Heart Failure
Background: Hypertension is associated with development of heart failure (HF), but its effects on HF outcomes is paradoxical. Advanced HF is associated with low systolic blood pressure (SBP) and poor prognosis. Our aim was to determine differential effects of baseline SBP on mortality in HF patients.
Methods: 7753 patients in Digitalis Intervention Group (DIG) trial were stratified into quartiles based on SBP: Group 1: ≤119, Group 2: 120 –129, Group 3: 130 –139, Group 4: ≥140 mmHg. To minimize differences in baseline characteristics, propensity matching was performed for 20 variables. Multivariate Cox regression analysis was performed for all cause mortality.
Results: With propensity matching, 700, 690, 555 and 556 patients were identified in groups 1, 2, 3 & 4. Mean SBP was 110, 122, 132 and 147 mmHg, respectively. Baseline characteristics were well matched for age, sex, race, diabetes, ischemic etiology, NYHA class, limitation of activity, DBP, heart rate, BMI, peripheral edema, S3, cardiothoracic ratio, congestion on x ray, LVEF, creatinine, use of ACE inhibitors, diuretics, potassium sparing diuretics and digoxin. There was a significant association of rising SBP subgroups with all cause mortality (p=0.006). Mortality was lowest in group 3, and higher for groups 1,2 & 4 (figure⇓).
Conclusion: In patients with stable HF, SBP of 130 –139 mmHg was associated with the best prognosis. Systolic hypertension, as expected, was associated with poor prognosis, along with SBP ≤129 mmHg at baseline, suggesting a U shaped curve for SBP effect on survival in patients with HF.