# Systolic blood pressure increase in chronic heart failure associates with survival advantage

## TL;DR

A rise in systolic blood pressure in chronic heart failure patients over one year is linked to a lower risk of death.

## Contribution

This study identifies a survival benefit in chronic heart failure patients with increased systolic blood pressure.

## Key findings

- A 10 mmHg or greater increase in systolic blood pressure was associated with a 39% reduction in all-cause mortality.
- Lower baseline systolic blood pressure and loop diuretic use predicted a systolic blood pressure increase.
- Patients with stable or decreased systolic blood pressure had a similarly poor prognosis.

## Abstract

The impact of systolic blood pressure (SBP) variation on chronic heart failure (HF) is largely unknown. We assessed the impact of SBP variation in patients with chronic HF.

This is a retrospective analysis of adult ambulatory patients with HF with left ventricular systolic dysfunction (LVSD). SBP variation = SBP at the index visit – SBP at the 1-year visit. Patients dying in the first year or with missing data concerning SBP were excluded. Patients with SBP increase ≥10 mmHg during the first year were compared with the remaining. Determinants of SBP increase were assessed by binary logistic regression analysis. The patients were followed up from the 1-year visit up to 5 years. The primary end point was all-cause mortality. A Cox regression analysis was used to determine the association of SBP variation with mortality.

We studied 787 patients (68% male), with a mean age of 70 years. SBP increased by ≥10 mmHg in 277 patients (35.2%) and remained stable or decreased in 510. Patients in whom SBP increased more often presented severe LVSD and nonischemic HF; they had lower baseline SBP and were more medicated with loop diuretics. Independent predictors of SBP increase were lower basal SBP and loop diuretic use. Patients with a SBP increase ≥10 mmHg had a crude hazard ratio (HR) of all-cause mortality of 0.74 (0.59–0.94), and the multivariate-adjusted HR was 0.61 (0.46–0.79).

Patients with chronic HF with SBP increase ≥10 mmHg over the first year have a 39% reduction in the all-cause mortality risk irrespective of basal SBP, severity of ventricular dysfunction, and evidence-based drug use. Patients with SBP stability or decrease have a similarly poor prognosis.