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

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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

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

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    Lee, S. E., Lee, H. Y., Cho, H. J., Choe, W. S., Kim, H., Choi, J. O., Jeon, E. S., Kim, M. S., Hwang, K. K., Chae, S. C., Baek, S. H., Kang, S. M., Choi, D. J., Yoo, B. S., Kim, K. H., Cho, M. C., Kim, J. J., & Oh, B. H. (2017). Reverse J-Curve Relationship Between On-Treatment Blood Pressure and Mortality in Patients With Heart Failure. JACC: Heart Failure, 5(11), 810-819. https://doi.org/10.1016/j.jchf.2017.08.015