Heart failure
Relation of Baseline Systolic Blood Pressure and Long-Term Outcomes in Ambulatory Patients With Chronic Mild to Moderate Heart Failure

https://doi.org/10.1016/j.amjcard.2010.12.020Get rights and content

We studied the impact of baseline systolic blood pressure (SBP) on outcomes in patients with mild to moderate chronic systolic and diastolic heart failure (HF) in the Digitalis Investigation Group trial using a propensity-matched design. Of 7,788 patients, 7,785 had baseline SBP data and 3,538 had SBP ≤120 mm Hg. Propensity scores for SBP ≤120 mm Hg, calculated for each of the 7,785 patients, were used to assemble a matched cohort of 3,738 patients with SBP ≤120 and >120 mm Hg who were well-balanced in 32 baseline characteristics. All-cause mortality occurred in 35% and 32% of matched patients with SBPs ≤120 and >120 mm Hg respectively, during 5 years of follow-up (hazard ratio [HR] when SBP ≤120 was compared to >120 mm Hg 1.10, 95% confidence interval [CI] 0.99 to 1.23, p = 0.088). HRs for cardiovascular and HF mortalities associated with SBP ≤120 mm Hg were 1.15 (95% CI 1.01 to 1.30, p = 0.031) and 1.30 (95% CI 1.08 to 1.57, p = 0.006). Cardiovascular hospitalization occurred in 53% and 49% of matched patients with SBPs ≤120 and >120 mm Hg, respectively (HR 1.13, 95% CI 1.03 to 1.24, p = 0.008). HRs for all-cause and HF hospitalizations associated with SBP ≤120 mm Hg were 1.10 (95% CI 1.02 to 1.194, p = 0.017) and 1.21 (95% CI 1.07 to 1.36, p = 0.002). In conclusion, in patients with mild to moderate long-term systolic and diastolic HF, baseline SBP ≤120 mm Hg was associated with increased cardiovascular and HF mortalities and all-cause, cardiovascular, and HF hospitalizations that was independent of other baseline characteristics.

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

References (29)

Cited by (87)

  • Heart Failure

    2023, Hypertension: A Companion to Braunwald's Heart Disease
  • Managing Hypertension in the elderly: What's new?

    2020, American Journal of Preventive Cardiology
View all citing articles on Scopus

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.

Drs. Banach and Bhatia contributed equally to this study.

View full text