Association of systolic blood pressure with mortality in patients with heart failure with reduced ejection fraction: A complex relationship

Ather, Sameer; Chan, Wenyaw; Chillar, Annirudha; Aguilar, David; Pritchett, Allison M.; Ramasubbu, Kumudha; Wehrens, Xander H.T.; Deswal, Anita; Bozkurt, Biykem

doi:10.1016/j.ahj.2010.12.009

Cited by 70 publications

(52 citation statements)

References 35 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The decrease in mortality rates associated with a 10-mm Hg higher SBP was 13.0% in the HF population. In a recent study by Ather et al 92 incorporating data from 2 large cohorts of ambulatory patients with chronic HF, it was noted that the relationship of BP and mortality is different in patients with mild and those with severe LV systolic dysfunction. In patients with mild to moderate LV systolic dysfunction, SBP was found to have a nonlinear U-shaped association with increased all-cause mortality at both the lower and upper ranges of SBP ( Figure 3A).…”

Section: Treatment Of Hypertension In Patients With Hf With Preservedmentioning

confidence: 99%

Contributory Risk and Management of Comorbidities of Hypertension, Obesity, Diabetes Mellitus, Hyperlipidemia, and Metabolic Syndrome in Chronic Heart Failure: A Scientific Statement From the American Heart Association

Bozkurt¹,

Aguilar²,

Deswal³

et al. 2016

Circulation

Self Cite

371

220

View full text Add to dashboard Cite

CLINICAL STATEMENTS AND GUIDELINESfailed to show a significant reduction of SBP in patients with resistant hypertension. 81 Other strategies such as targeting excessive sympathetic nerve activity by carotid body denervation are awaiting clinical validation in the hypertension and HF populations. Drugs to Avoid in Patients With HFSeveral classes of drugs should be avoided in patients with HFrEF with a history of hypertension. Because of their negative inotropic properties and the increased likelihood of worsening HF symptoms, the nondihydropyridine calcium channel blockers such as diltiazem and verapamil should be avoided. 8 The dihydropyridine calcium channel blocker amlodipine appeared to be safe in patients with severe HFrEF in the PRAISE trial (Prospective Randomized Amlodipine Survival Evaluation), 82 as was felodipine. 73 In the current 2013 HF guidelines, most calcium channelblocking drugs except amlodipine are not recommended. 8Although clonidine is an effective antihypertensive agent, a similar centrally acting drug, moxonidine, was associated with increased mortality in patients with HF; thus, centrally acting norepinephrine-depleting agents may need to be avoided or used with caution in patients with HFrEF. 83In the ALLHAT trial, the α-blocker doxazosin arm of the trial was discontinued because of a 2-fold increase in the risk of developing HF compared with chlorthalidone treatment. 45 Although the ALLHAT study excluded patients with established HF and there are caveats about extrapolating these data to the management of hypertension in patients with established HF, the safety and efficacy of α-blockers in the management of patients with HF with hypertension are currently unclear. Potent direct-acting vasodilators such as minoxidil should also be avoided because of their renin-related salt and fluid-retaining effects. Nonsteroidal anti-inflammatory agents should be used with caution in these patients, given their effects on BP, volume status, and renal function. Treatment of Hypertension in Patients With HF With Preserved LVEFMost patients with HF and preserved LVEF (HFpEF), especially elderly women, have hypertension. A significant proportion of these patients also have evidence of LV hypertrophy, and some may have atrial dilatation, cardiac enlargement, and wall motion abnormalities without LV systolic dysfunction. Patients with HFpEF may respond particularly well to the treatment of hypertension with regression of hypertrophy 84 and improvement in filling pressures. 84,85 Most patients with HFpEF require treatment with cardiac medications for the comorbidities of hypertension, diabetes mellitus, coronary artery disease, and atrial fibrillation. The 2013 HF guidelines suggest that the use of β-blocking agents, ACE inhibitors, and ARBs in patients with hypertension is reasonable to control BP in patients with HFpEF. 8 The use of ARBs might also be considered to decrease hospitalizations for patients with HFpEF. recommendations Harmonized With Existing Guidelines for the recognition and Treatment of pa...

show abstract

Section: Treatment Of Hypertension In Patients With Hf With Preservedmentioning

confidence: 99%

Contributory Risk and Management of Comorbidities of Hypertension, Obesity, Diabetes Mellitus, Hyperlipidemia, and Metabolic Syndrome in Chronic Heart Failure: A Scientific Statement From the American Heart Association

Bozkurt¹,

Aguilar²,

Deswal³

et al. 2016

Circulation

Self Cite

371

220

View full text Add to dashboard Cite

show abstract

“…Despite recent advances in treatment, mortality is still high (12% per year) in stable patients, and there is a high rate of hospital readmissions due to worsening HF [3,4] . Even though a high number of clinical parameters have been associated with poor outcome in patients with stable HF, the assessment of prognosis is still a challenge [5,6] . Multiple biomarkers have been suggested to identify patients with worse prognosis, such as some interleukins, natriuretic peptides, endothelin, ST2, and several fibrosis markers [7][8][9][10][11] .…”

Section: Introductionmentioning

confidence: 99%

Prognostic value of increased carbohydrate antigen in patients with heart failure

Méndez

Ordóñez-Llanos

Ferrero

et al. 2014

WJC

View full text Add to dashboard Cite

Author contributions: Mendez AB contributed to design of the study, analysis and interpretation of data, manuscript writing and final approval of manuscript; Ordoñez-Llanos J contributed to analysis of data, review of CA125 and NT-proBNP determinations and substantial contribution to manuscript review; Ferrero A contributed to statistical assessment and substantial contribution to manuscript review; Noguero M contributed to patient selection and follow-up, Serotec and analysis of data; Mir T and Mora J contributed to CA125 and NT-proBNP determinations, analysis of data, substantial contribution to manuscript; Bayes-Genis A and Mirabet S contributed to patient selection and follow-up, analysis of data, substantial contribution to manuscript; Cinca J contributed to design of the study and substantial contribution to manuscript review; Roig E contributed to design of the study, selection of patients, analysis of data, and substantial contribution to manuscript review. Abstract AIM: To study the prognostic value of carbohydrate antigen 125 (CA125) and whether it adds prognostic information to N-terminal pro-brain natriuretic peptide (NT-proBNP) in stable heart failure (HF) patients. METHODS:The predictive value of CA125 was retrospectively assessed in 156 patients with stable HF remitted to the outpatient HF unit for monitoring from 2009 to 2011. Patients were included in the study if they had a previous documented episode of HF and received HF treatment. CA125 and NT-proBNP concentrations were measured. The independent association between NT-proBNP or CA125 and mortality was assessed with Cox regression analysis, and their combined predictive ability was tested by the integrated discrimination improvement (IDI) index. RESULTS:The mean age of the 156 patients was 72 ± 12 years. During follow-up (17 ± 8 mo), 27 patients died, 1 received an urgent heart transplantation and 106 required hospitalization for HF. Higher CA125 values were correlated with outcomes: 58 ± 85 KU/L if hospitalized vs 34 ± 61 KU/L if not (P < 0.05), and 94 ± 121 KU/L in those who died or needed urgent heart transplantation vs 45 ± 78 KU/L in survivors (P < 0.01).After adjusting for propensity scores, the highest risk was observed when both biomarkers were elevated vs not elevated (HR = 8.95, 95%CI: 3.11-25.73; P < 0.001) and intermediate when only NT-proBNP was elevated vs not elevated (HR = 4.15, 95%CI: 1.41-12.24; P < 0.01). Moreover, when CA125 was added to the clinical model with NT-proBNP, a 4% (P < 0.05) improvement in the IDI was found.CONCLUSION: CA125 > 60 KU/L identified patients in stable HF with poor survival. Circulating CA125 level adds prognostic value to NT-proBNP level in predicting HF outcomes.© 2014 Baishideng Publishing Group Co., Limited. All rights reserved. Key words: Heart failure; Prognosis; Carbohydrate antigen 125; Brain natriuretic peptides; Survival Core tip: Increased carbohydrate antigen 125 (CA125) has prognostic implications in acute heart failure (HF). The aim of this study was to assess the prognostic value of ...

show abstract

“…In real-world patients with chronic HF, the prevalence of hypotension seems to be in the range of 5% to 10%. 1 Similarly, ≈3% to 10% of hospitalized patients with HF have SBP<100 mm Hg on admission.…”

Section: Hypotension As Side Effect Of Hf Treatmentmentioning

confidence: 99%

“…Once HF is manifest, lower BP is associated with a worse prognosis, more commonly so in patients with systolic HF. 1 Because cardiac output is a major determinant of BP, BP declines with advanced pump failure, reflecting severity of systolic HF. It should be kept in mind that other than advanced pump failure, hypotension can be caused by other conditions such as overdiuresis or dehydration, acute coronary syndrome, ischemia, arrhythmia, autonomic dysfunction, gastrointestinal bleeding, or infection.…”

Section: Treating the Patient Not Necessarily The Bp Measurement Ismentioning

confidence: 99%

Association of systolic blood pressure with mortality in patients with heart failure with reduced ejection fraction: A complex relationship

Cited by 70 publications

References 35 publications

Contributory Risk and Management of Comorbidities of Hypertension, Obesity, Diabetes Mellitus, Hyperlipidemia, and Metabolic Syndrome in Chronic Heart Failure: A Scientific Statement From the American Heart Association

Contributory Risk and Management of Comorbidities of Hypertension, Obesity, Diabetes Mellitus, Hyperlipidemia, and Metabolic Syndrome in Chronic Heart Failure: A Scientific Statement From the American Heart Association

Prognostic value of increased carbohydrate antigen in patients with heart failure

Response to Ryan and Parwani: Heart Failure Patients With Low Blood Pressure: How Should We Manage Neurohormonal Blocking Drugs?

Contact Info

Product

Resources

About