The association between blood pressure and mortality in patients with heart failure

Lee, Tobias T.; Chen, Jersey; Cohen, David J.; Tsao, Lana

doi:10.1016/j.ahj.2005.03.009

Cited by 132 publications

(106 citation statements)

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“…In these studies, increasing blood pressure has generally been associated with improved prognosis, even for patients with blood pressure in the normal and high range. [31][32][33][34][35] This finding may be explained in part by the fact that 44% of the patients in VALIANT were in NYHA class 1 at the 6-month follow-up visit, and only 11% were in class 3 or 4. Thus, whereas cardiac function may be the main determinant of outcome in the HF population, in post-MI patients without overt HF, elevated blood pressure may be more common and may reflect an increased risk of ischemic events.…”

Section: Discussionmentioning

confidence: 73%

Effect of Antecedent Hypertension and Follow-Up Blood Pressure on Outcomes After High-Risk Myocardial Infarction

et al. 2008

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Abstract-The influence of blood pressure on outcomes after high-risk myocardial infarction is not well characterized. We studied the relationship between blood pressure and the risk of cardiovascular events in 14 703 patients with heart failure, left ventricular systolic dysfunction, or both after acute myocardial infarction in the Valsartan in Myocardial Infarction Trial. We assessed the relationship between antecedent hypertension and outcomes and the association between elevated (systolic: Ͼ140 mm Hg) or low blood pressure (systolic: Ͻ100 mm Hg) in 2 of 3 follow-up visits during the first 6 months and subsequent cardiovascular events over a median 24.

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Section: Discussionmentioning

confidence: 73%

Effect of Antecedent Hypertension and Follow-Up Blood Pressure on Outcomes After High-Risk Myocardial Infarction

et al. 2008

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“…The fifth most vulnerable class had a very high prevalence of all diseases, making it the Extensive Multimorbidity class. Of note, the measured blood pressure of those in this class was usually lower than that in the other classes, consistent with advanced heart failure (28).…”

Section: Mm: Distinct Classes Distinguished By Diabetes and Hypertensmentioning

confidence: 75%

Empirical redefinition of comprehensive health and well-being in the older adults of the United States

McClintock

Dale

Laumann

et al. 2016

Proc. Natl. Acad. Sci. U.S.A.

115

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The World Health Organization (WHO) defines health as a "state of complete physical, mental and social well-being and not merely the absence of disease or infirmity." Despite general acceptance of this comprehensive definition, there has been little rigorous scientific attempt to use it to measure and assess population health. Instead, the dominant model of health is a disease-centered Medical Model (MM), which actively ignores many relevant domains. In contrast to the MM, we approach this issue through a Comprehensive Model (CM) of health consistent with the WHO definition, giving statistically equal consideration to multiple health domains, including medical, physical, psychological, functional, and sensory measures. We apply a data-driven latent class analysis (LCA) to model 54 specific health variables from the National Social Life, Health, and Aging Project (NSHAP), a nationally representative sample of US community-dwelling older adults. We first apply the LCA to the MM, identifying five health classes differentiated primarily by having diabetes and hypertension. The CM identifies a broader range of six health classes, including two "emergent" classes completely obscured by the MM. We find that specific medical diagnoses (cancer and hypertension) and health behaviors (smoking) are far less important than mental health (loneliness), sensory function (hearing), mobility, and bone fractures in defining vulnerable health classes. Although the MM places two-thirds of the US population into "robust health" classes, the CM reveals that one-half belong to less healthy classes, independently associated with higher mortality. This reconceptualization has important implications for medical care delivery, preventive health practices, and resource allocation.comprehensive health | aging | disease | well-being | health policy I n 1946, the World Health Organization (WHO) defined health as "a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity" (1). In 1977, George Engel (2) built on this definition, calling for a new biopsychosocial model. It integrated traditional medicine with psychosocial factors, which stimulated the field of psychosomatic medicine. These ideas have been honored more as an ideal than in practice.Here, we seek to apply this comprehensive definition to characterize the health of US older adults living in their homes. Studying a representative sample of the US population ages 57-85 y old [the National Social Life, Health and Aging Project (NSHAP)], we gathered wide-ranging information on the diseases of the traditional "Medical Model" (MM) and also, psychological well-being and physical function in a "Comprehensive Model" (CM) informed by the approach by Engel (2, 3). We empirically determined if these health measures formed distinct constellations, characterizing groups of people with different patterns of health and well-being. Our large survey of 3,005 community-dwelling older adults ages 57-85 y old was not a clinical sample or a sample of con...

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“…Several studies have reported that lower SBP predicts worse outcome both in the acute HF setting [4-6, 11, 17-23] and in a chronic HF context [14][15][16][17]. The reason for this blood pressure paradox, like other reverse epidemiology phenomena in HF, is not completely understood.…”

Section: Discussionmentioning

confidence: 96%

“…However, once HF is established, patients with higher systolic blood pressure (SBP) appear to have better prognosis. This survival benefit is present in both chronic stable HF with or without left ventricular systolic dysfunction (LVSD) [14][15][16][17] as well as in acute decompensated HF irrespective of left ventricular function [4-6, 11, 17-23].…”

Section: Introductionmentioning

confidence: 99%

Is the blood pressure paradox observed in all heart failure patients?

Cunha

Lourenço

Couto

et al. 2013

European Heart Journal

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Background. Heart failure (HF) patients with higher systolic blood pressure (SBP) survive longer. Diabetes mellitus (DM) is a frequent comorbidity in HF. We evaluated the prognostic significance of low SBP according to DM in acute HF. Methods. We prospectively recruited 589 patients admitted with acute HF. DM was defined according to the 2011 American Diabetes Association recommendations. Patients were followed for 6 months and HF-death was the endpoint. A multivariate Cox-regression model was used to assess the prognostic impact of SBP. A stratified analysis according to DM was performed. Results. Median patients' age was 79 years and DM was present in 50.8%. Ischemic aetiology HF and hypertension history were more common in diabetics. Diabetic patients had worse renal function and lower total cholesterol and were more often discharged with antiplatelet therapy and statin. During followup, 89 patients died due to HF. The multivariate-adjusted HR for the 6-month HF death in non-diabetic patients with an admission SBP < 115 mmHg (1st quartile) was 2.94 (95% CI: 1.49-5.79), while lower admission SBP was not associated with HF mortality in diabetics. Conclusions. The blood pressure paradox in HF is only observed in non-diabetic HF patients. Diabetic patients seem to be a particular subgroup of HF patients.

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The association between blood pressure and mortality in patients with heart failure

Cited by 132 publications

References 15 publications

Effect of Antecedent Hypertension and Follow-Up Blood Pressure on Outcomes After High-Risk Myocardial Infarction

Effect of Antecedent Hypertension and Follow-Up Blood Pressure on Outcomes After High-Risk Myocardial Infarction

Empirical redefinition of comprehensive health and well-being in the older adults of the United States

Is the blood pressure paradox observed in all heart failure patients?

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