Heart failureRelation of Baseline Systolic Blood Pressure and Long-Term Outcomes in Ambulatory Patients With Chronic Mild to Moderate Heart Failure
Section snippets
Methods
A public-use copy of the Digitalis Investigation Group (DIG) dataset was used for the present analysis. The DIG was a multicenter randomized placebo-controlled clinical trial of digoxin in patients with HF.10 Briefly, 7,788 patients with advanced chronic systolic HF were enrolled from 302 different sites across the United States and Canada from February 1991 through August 1993. At baseline patients had a mean duration of 17 months of HF and had a mean left ventricular ejection fraction (LVEF)
Results
Matched patients had a mean age of 64 ± 10 years with 23% women and 14% nonwhites. Matched patients with SBP ≤120 mm Hg had a median SBP of 114 mm Hg (interquartile range 10) and those with SBP >120 mm Hg had a median SBP of 134 mm Hg (interquartile range 10). More than 90% of matched patients with SBP ≤120 mm Hg had their SBP from 110 to 120 mm Hg. Before matching, patients with SBP ≤120 mm Hg were younger (by a mean age of 3 years) and had a lower prevalence of hypertension, diabetes, and
Discussion
Results of the present analysis demonstrate that in patients with mild to moderate HF, baseline SBP ≤120 mm Hg was associated with increased long-term mortality and hospitalization, which remained significant for all outcomes except all-cause mortality in a well-balanced propensity-matched cohort. These findings suggest that baseline SBP ≤120 mm Hg is a powerful predictor of poor outcomes even in ambulatory patients with mild to moderate chronic HF and that these associations are at least part
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Dr. Ahmed is supported by the National Institutes of Health through Grants R01-HL085561 and R01-HL097047 from the National Heart, Lung, and Blood Institute, Bethesda, Maryland and a generous gift from Ms. Jean B. Morris, Birmingham, Alabama. The Digitalis Investigation Group study was conducted and supported by the National Heart, Lung, and Blood Institute in collaboration with the Digitalis Investigation Group Investigators.
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Drs. Banach and Bhatia contributed equally to this study.