Rate pressure product and the components of heart rate and systolic blood pressure in hospitalized heart failure patients with preserved ejection fraction: Insights from ASCEND‐HF

Abstract

Background Heart rate and systolic blood pressure (SBP) are prognostic markers in heart failure (HF) with reduced ejection fraction (HFrEF). Their combination in rate pressure product (RPP) as well as their role in heart failure with preserved ejection fraction (HFpEF) remains unclear. Hypothesis RPP and its components are associated with HFpEF outcomes. Methods We performed an analysis of Acute Study of Clinical Effectiveness of Nesiritide in Subjects With Decompensated Heart Failure (ASCEND‐HF; http://www.clinicaltrials.gov NCT00475852), which studied 7141 patients with acute HF. HFpEF was defined as left ventricular ejection fraction ≥40%. Outcomes were assessed by baseline heart rate, SBP, and RPP, as well as the change of these variables using adjusted Cox models. Results After multivariable adjustment, in‐hospital change but not baseline heart rate, SBP, and RPP were associated with 30‐day mortality/HF hospitalization (hazard ratio [HR]: 1.17 per 5‐bpm heart rate, HR: 1.20 per 10‐mm Hg SBP, and HR: 1.02 per 100 bpm × mm Hg RPP; all P < 0.05). Baseline SBP was associated with 180‐day mortality (HR: 0.88 per 10‐mm Hg, P = 0.028). Though change in RPP was associated with 30‐day mortality/HF hospitalization, the RPP baseline variable did not provide additional associative information with regard to outcomes when compared with assessment of baseline heart rate and SBP variables alone. Conclusions An increase in heart rate and SBP from baseline to discharge was associated with increased 30‐day mortality/HF hospitalization in HFpEF patients with acute exacerbation. These findings suggest value in monitoring the trend of vital signs during HFpEF hospitalization.

Association of double product and pulse pressure with cardiovascular and all‐cause mortality in the LURIC study

“…In the Acute Study of Clinical Effectiveness of Nesiritide in Subjects With Decompensated Heart Failure (ASCEND‐HF), an in‐hospital rise of DP from baseline to discharge but not DP at baseline alone was associated with higher 30‐day mortality/HF hospitalization in patients with HFpEF 12 …”

“…11 In the Acute Study of Clinical Effectiveness of Nesiritide in Subjects With Decompensated Heart Failure (ASCEND-HF), an in-hospital rise of DP from baseline to discharge but not DP at baseline alone was associated with higher 30-day mortality/HF hospitalization in patients with HFpEF. 12 The aim of our study was to analyze the role of blood pressure components SBP, DBP, and PP as well as the double product on CV mortality and all-cause mortality in a patient cohort with a high percentage of coronary artery disease (CAD) and heart failure (HF).…”

A Novel and Simply Calculated Cardiac Load Index Correlates With Coronary Artery Disease

“…This study was the rst to provide the concept of SBP × HR / LVEF representing CLI. The SBP and HR product is an indirect index of cardiac work, which can predict cardiac function, morbidity, and mortality in patients with cardiovascular disease [10]. LVEF is a valuable diagnostic and prognostic tool for cardiovascular disease, and re ects cardiac function and remodeling [11].…”

Long-Term Predialysis Systolic Blood Pressure Variability and Intradialytic Cardiac Hemodynamics in Hemodialysis Patients

“…Previous studies have demonstrated that the RPP highly correlates with invasive measurement of myocardial oxygen consumption, and it is used as an index of myocardial workload and oxygen demand to predict cardiac function, morbidity and mortality 11,12 . Cardiovascular reactivity to acute stress is mediated via the activation of the sympathetic nervous system and hypothalamus-pituitary-adrenal axis, leading to increase in heart rate, blood pressure, vasoconstriction, and vagal withdrawal 13 .…”