Reverse J-Curve Relationship Between On-Treatment Blood Pressure and Mortality in Patients With Heart Failure

Sang Eun Lee, Hae Young Lee, Hyun Jai Cho, Won Seok Choe, Hokon Kim, Jin Oh Choi, Eun Seok Jeon, Min Seok Kim, Kyung Kuk Hwang, Shung Chull Chae, Sang Hong Baek, Seok Min Kang, Dong Ju Choi, Byung Su Yoo, Kye Hun Kim, Myeong Chan Cho, Jae Joong Kim, Byung Hee Oh

Research output: Contribution to journalArticle

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Abstract

Objectives This study aimed to assess the relationship between on-treatment blood pressure (BP) and clinical outcomes of patients with heart failure (HF). Background Lower BP has been reported to be related to increased mortality in various cardiovascular diseases. The optimal BP level for patients already experiencing HF is contentious. Methods The Korean Acute Heart Failure registry prospectively enrolled a total of 5,625 consecutive patients hospitalized for acute HF in 10 tertiary university hospitals in Korea between March 2011 and February 2014. Clinical profiles including BP were collected at admission, discharge, and during outpatient follow-up. Mean on-treatment BP was calculated from BP at discharge and at each follow-up visit. We evaluated the effects of mean on-treatment BP on the clinical outcomes of patients. Results Patients were followed up for a median 2.2 years. One-year mortality after discharge was 18.2%. The relationship between on-treatment BP and all-cause mortality followed a reversed J-curve relationship. A nonlinear, multivariable Cox proportional hazard model identified a nadir of systolic and diastolic BPs of 132.4/74.2 mm Hg in patients, for whom the mortality rate was lowest (p < 0.0001). The relationship with increased mortality above and below the reference BP was more definitive for diastolic BP and for HF with a preserved ejection fraction. Conclusions Systolic and diastolic BPs <130/70 mm Hg at discharge and during follow-up was associated with worse survival in HF patients. These data suggest that the lowest BP possible might not be an optimal target for HF patients. Further studies should establish a proper BP goal in HF patients. (Registry [Prospective Cohort] for Heart Failure in Korea [KorAHF]; NCT01389843)

Original languageEnglish
Pages (from-to)810-819
Number of pages10
JournalJACC: Heart Failure
Volume5
Issue number11
DOIs
Publication statusPublished - 2017 Nov

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Heart Failure
Blood Pressure
Mortality
Therapeutics
Korea
Registries
Proportional Hazards Models
Tertiary Care Centers
Hypotension
Outpatients
Cardiovascular Diseases
Survival

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Lee, Sang Eun ; Lee, Hae Young ; Cho, Hyun Jai ; Choe, Won Seok ; Kim, Hokon ; Choi, Jin Oh ; Jeon, Eun Seok ; Kim, Min Seok ; Hwang, Kyung Kuk ; Chae, Shung Chull ; Baek, Sang Hong ; Kang, Seok Min ; Choi, Dong Ju ; Yoo, Byung Su ; Kim, Kye Hun ; Cho, Myeong Chan ; Kim, Jae Joong ; Oh, Byung Hee. / Reverse J-Curve Relationship Between On-Treatment Blood Pressure and Mortality in Patients With Heart Failure. In: JACC: Heart Failure. 2017 ; Vol. 5, No. 11. pp. 810-819.
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title = "Reverse J-Curve Relationship Between On-Treatment Blood Pressure and Mortality in Patients With Heart Failure",
abstract = "Objectives This study aimed to assess the relationship between on-treatment blood pressure (BP) and clinical outcomes of patients with heart failure (HF). Background Lower BP has been reported to be related to increased mortality in various cardiovascular diseases. The optimal BP level for patients already experiencing HF is contentious. Methods The Korean Acute Heart Failure registry prospectively enrolled a total of 5,625 consecutive patients hospitalized for acute HF in 10 tertiary university hospitals in Korea between March 2011 and February 2014. Clinical profiles including BP were collected at admission, discharge, and during outpatient follow-up. Mean on-treatment BP was calculated from BP at discharge and at each follow-up visit. We evaluated the effects of mean on-treatment BP on the clinical outcomes of patients. Results Patients were followed up for a median 2.2 years. One-year mortality after discharge was 18.2{\%}. The relationship between on-treatment BP and all-cause mortality followed a reversed J-curve relationship. A nonlinear, multivariable Cox proportional hazard model identified a nadir of systolic and diastolic BPs of 132.4/74.2 mm Hg in patients, for whom the mortality rate was lowest (p < 0.0001). The relationship with increased mortality above and below the reference BP was more definitive for diastolic BP and for HF with a preserved ejection fraction. Conclusions Systolic and diastolic BPs <130/70 mm Hg at discharge and during follow-up was associated with worse survival in HF patients. These data suggest that the lowest BP possible might not be an optimal target for HF patients. Further studies should establish a proper BP goal in HF patients. (Registry [Prospective Cohort] for Heart Failure in Korea [KorAHF]; NCT01389843)",
author = "Lee, {Sang Eun} and Lee, {Hae Young} and Cho, {Hyun Jai} and Choe, {Won Seok} and Hokon Kim and Choi, {Jin Oh} and Jeon, {Eun Seok} and Kim, {Min Seok} and Hwang, {Kyung Kuk} and Chae, {Shung Chull} and Baek, {Sang Hong} and Kang, {Seok Min} and Choi, {Dong Ju} and Yoo, {Byung Su} and Kim, {Kye Hun} and Cho, {Myeong Chan} and Kim, {Jae Joong} and Oh, {Byung Hee}",
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Lee, SE, Lee, HY, Cho, HJ, Choe, WS, Kim, H, Choi, JO, Jeon, ES, Kim, MS, Hwang, KK, Chae, SC, Baek, SH, Kang, SM, Choi, DJ, Yoo, BS, Kim, KH, Cho, MC, Kim, JJ & Oh, BH 2017, 'Reverse J-Curve Relationship Between On-Treatment Blood Pressure and Mortality in Patients With Heart Failure', JACC: Heart Failure, vol. 5, no. 11, pp. 810-819. https://doi.org/10.1016/j.jchf.2017.08.015

Reverse J-Curve Relationship Between On-Treatment Blood Pressure and Mortality in Patients With Heart Failure. / Lee, Sang Eun; Lee, Hae Young; Cho, Hyun Jai; Choe, Won Seok; Kim, Hokon; Choi, Jin Oh; Jeon, Eun Seok; Kim, Min Seok; Hwang, Kyung Kuk; Chae, Shung Chull; Baek, Sang Hong; Kang, Seok Min; Choi, Dong Ju; Yoo, Byung Su; Kim, Kye Hun; Cho, Myeong Chan; Kim, Jae Joong; Oh, Byung Hee.

In: JACC: Heart Failure, Vol. 5, No. 11, 11.2017, p. 810-819.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Reverse J-Curve Relationship Between On-Treatment Blood Pressure and Mortality in Patients With Heart Failure

AU - Lee, Sang Eun

AU - Lee, Hae Young

AU - Cho, Hyun Jai

AU - Choe, Won Seok

AU - Kim, Hokon

AU - Choi, Jin Oh

AU - Jeon, Eun Seok

AU - Kim, Min Seok

AU - Hwang, Kyung Kuk

AU - Chae, Shung Chull

AU - Baek, Sang Hong

AU - Kang, Seok Min

AU - Choi, Dong Ju

AU - Yoo, Byung Su

AU - Kim, Kye Hun

AU - Cho, Myeong Chan

AU - Kim, Jae Joong

AU - Oh, Byung Hee

PY - 2017/11

Y1 - 2017/11

N2 - Objectives This study aimed to assess the relationship between on-treatment blood pressure (BP) and clinical outcomes of patients with heart failure (HF). Background Lower BP has been reported to be related to increased mortality in various cardiovascular diseases. The optimal BP level for patients already experiencing HF is contentious. Methods The Korean Acute Heart Failure registry prospectively enrolled a total of 5,625 consecutive patients hospitalized for acute HF in 10 tertiary university hospitals in Korea between March 2011 and February 2014. Clinical profiles including BP were collected at admission, discharge, and during outpatient follow-up. Mean on-treatment BP was calculated from BP at discharge and at each follow-up visit. We evaluated the effects of mean on-treatment BP on the clinical outcomes of patients. Results Patients were followed up for a median 2.2 years. One-year mortality after discharge was 18.2%. The relationship between on-treatment BP and all-cause mortality followed a reversed J-curve relationship. A nonlinear, multivariable Cox proportional hazard model identified a nadir of systolic and diastolic BPs of 132.4/74.2 mm Hg in patients, for whom the mortality rate was lowest (p < 0.0001). The relationship with increased mortality above and below the reference BP was more definitive for diastolic BP and for HF with a preserved ejection fraction. Conclusions Systolic and diastolic BPs <130/70 mm Hg at discharge and during follow-up was associated with worse survival in HF patients. These data suggest that the lowest BP possible might not be an optimal target for HF patients. Further studies should establish a proper BP goal in HF patients. (Registry [Prospective Cohort] for Heart Failure in Korea [KorAHF]; NCT01389843)

AB - Objectives This study aimed to assess the relationship between on-treatment blood pressure (BP) and clinical outcomes of patients with heart failure (HF). Background Lower BP has been reported to be related to increased mortality in various cardiovascular diseases. The optimal BP level for patients already experiencing HF is contentious. Methods The Korean Acute Heart Failure registry prospectively enrolled a total of 5,625 consecutive patients hospitalized for acute HF in 10 tertiary university hospitals in Korea between March 2011 and February 2014. Clinical profiles including BP were collected at admission, discharge, and during outpatient follow-up. Mean on-treatment BP was calculated from BP at discharge and at each follow-up visit. We evaluated the effects of mean on-treatment BP on the clinical outcomes of patients. Results Patients were followed up for a median 2.2 years. One-year mortality after discharge was 18.2%. The relationship between on-treatment BP and all-cause mortality followed a reversed J-curve relationship. A nonlinear, multivariable Cox proportional hazard model identified a nadir of systolic and diastolic BPs of 132.4/74.2 mm Hg in patients, for whom the mortality rate was lowest (p < 0.0001). The relationship with increased mortality above and below the reference BP was more definitive for diastolic BP and for HF with a preserved ejection fraction. Conclusions Systolic and diastolic BPs <130/70 mm Hg at discharge and during follow-up was associated with worse survival in HF patients. These data suggest that the lowest BP possible might not be an optimal target for HF patients. Further studies should establish a proper BP goal in HF patients. (Registry [Prospective Cohort] for Heart Failure in Korea [KorAHF]; NCT01389843)

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U2 - 10.1016/j.jchf.2017.08.015

DO - 10.1016/j.jchf.2017.08.015

M3 - Article

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VL - 5

SP - 810

EP - 819

JO - JACC: Heart Failure

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SN - 2213-1779

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