2017

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2017/№3

Effects of systolic and diastolic blood pressure and its changes between successive hospitalizations on prognosis for patients with acute decompensated CHF

Polyakov D. S., Fomin I. V., Badin Yu. V., Vaysberg A. R ., Valikulova F. Yu., Shechrbinina E. V., Kraiem N.
Federal State Budgetary Educational Institution of Higher Education, "Nizhny Novgorod State Medical Academy" of the Ministry of Health of the Russian Federation, pl. Minina i Pozharskogo 10/1, Nizhny Novgorod 603005

Keywords: life expectancy, acute decompensated heart failure, blood pressure

DOI: 10.18087/rhfj.2017.3.2357

Background. At present, there is no definitive opinion on how BP levels influence the prognosis of patients during hospitalization for acute decompensated heart failure (ADHF). Identifying predictors (including hemodynamic) for unfavorable prognosis in ADHF patients may become a determinant tactic approach to an improvement of the prognosis. Aim. To evaluate effects of SBP and DBP and their changes on prognosis of patients with CHF between successive hospitalizations for ADHF. Materials and methods. A retrospective analysis of a hospital sample of patients with ADHF (852 hospitalizations) was performed. Based on BP, patients were divided into 4 quartiles. Results. At the moment of the primary hospitalization, mean SBP was 142.5±30.2 mm Hg and DBP was 84.5±14.5 mm Hg. 57.5% of patients had SBP >140 mm Hg. The lower was the BP at hospitalization (quartile 1) the higher was the inhospital mortality; the inhospital mortality values were 5.3‑8.2 times for SBP and 4.7‑8.5 times higher for DBP than the values in higher quartiles (р<0.001). At a readmission within a year, SBP and DBP were lower in 43.6% and 51.3% of patients, respectively; BP remained unchanged in 34.6% and 25.6% of patients, respectively. Transition of BP to a lower quartile was associated with a ten‑dency toward a worse prognosis. The major causes for CHF in higher BP quartiles were AH, DM, and clinically pronounced IHD. Less frequent causes were permanent atrial fibrillation, postinfarction cardiosclerosis (PICS), heart defects, dilated cardiomyopathy (DCMP), chronic obstructive pulmonary disease (COPD), and bronchial asthma. The highest incidence of severe comorbidities was observed in patients of quartile 1 with low BP while the lowest incidence was observed in patients of BP quartile 4. Conclusion. More than a half of patients with CHF admitted for ADHF had SBP >140 mm HG and DBP >80 mm Hg on the first day. The risk of inhospital death inversely correlated with BP quartiles. The highest risk of death corresponded to the BP low quartile (SBP ≤120 mm Hg; DBP ≤75 mm Hg). For readmission, the risk of inhospital mortality was associated only with decreased or unchanged BP compared with the BP level during the previous hospitalization.
  1. Authors/Task Force Members, Mancia G, Fagard R, Narkiewicz K, Redon J, Zanchetti A et al. 2013 ESH/ESC Guidelines for the management of arterial hypertension: The Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). European Heart Journal. 2013;34(28):2159–219. DOI:10.1093/eurheartj/eht151.
  2. Bangalore S, Messerli FH, Wun C‑C, Zuckerman AL, DeMicco D, Kostis JB et al. J‑curve revisited: an analysis of blood pressure and cardiovascular events in the Treating to New Targets (TNT) Trial. European Heart Journal. 2010;31(23):2897–908. DOI:10.1093/eurheartj/ehq328.
  3. Gheorghiade M, Abraham WT, Albert NM, Greenberg BH, O’Connor CM, She L et al. Systolic Blood Pressure at Admission, Clinical Characteristics, and Outcomes in Patients Hospitalized With Acute Heart Failure. JAMA. 2006;296(18):2217. DOI:10.1001/jama.296.18.2217.
  4. Milo‑Cotter O, Adams KF, O’Connor CM, Uriel N, Kaluski E, Felker GM et al. Acute heart failure associated with high admission blood pressure ‑ A distinct vascular disorder? European Journal of Heart Failure. 2007;9(2):178–83. DOI:10.1016/j.ejheart.2006.06.004.
  5. Perez‑Calvo JI, Montero‑Perez‑Barquero M, Camafort‑Babkowski M, Conthe‑Gutierrez P, Formiga F, Aramburu‑Bodas O et al. Influence of admission blood pressure on mortality in patients with acute decompensated heart failure. QJM. 2011;104(4):325–33. DOI:10.1093/qjmed/hcq202.
  6. Поляков Д. С., Фомин И. В., Валикулова Ф. Ю., Вайсберг А. Р., Краием Н., Бадин Ю. В. и др. Эпидемиологическая программа ЭПОХА–ХСН: декомпенсация хронической сердечной недостаточности в реальной клинической практике (ЭПОХА–Д–ХСН). Журнал Сердечная Недостаточность. 2016;17(6):299–305. DOI:10.18087/rhfj.2016.5.2239 [Polyakov D. S., Fomin I. V., Valikulova F. Yu., Vajsberg A. R., Kraiem N., Badin Yu. V. i dr. E`pidemiologicheskaya programma E`POXA–XSN: dekompensacziya xronicheskoj serdechnoj nedostatochnosti v real`noj klinicheskoj praktike (E`POXA–D–XSN). Zhurnal Serdechnaya Nedostatochnost`. 2016;17(6):299–305. DOI:10.18087/rhfj.2016.5.2239].
  7. Adams KF, Fonarow GC, Emerman CL, LeJemtel TH, Costanzo MR , Abraham WT et al. Characteristics and outcomes of patients hospitalized for heart failure in the United States: Rationale, design, and preliminary observations from the first 100,000 cases in the Acute Decompensated Heart Failure National Registry (ADHERE). American Heart Journal. 2005;149(2):209–16. DOI:10.1016/j.ahj.2004.08.005.
  8. Núñez J, Núñez E, Fonarow GC, Sanchis J, Bodí V, Bertomeu‑González V et al. Differential prognostic effect of systolic blood pressure on mortality according to left‑ventricular function in patients with acute heart failure. European Journal of Heart Failure. 2010;12(1):38–44. DOI:10.1093/eurjhf/hfp176.
  9. Арутюнов А. Г., Драгунов Д. О., Арутюнов Г. П., Рылова А. К., Пашкевич Д. Д., Витер К. В. и др. Первое открытое исследование синдрома острой декомпенсации сердечной недостаточности и сопутствующих заболеваний в Российской Федерации. Независимый регистр ОРАКУЛ–РФ. Кардиология. 2015;55(5):12–21 [Arutyunov A. G., Dragunov D. O., Arutyunov G. P., Ry`lova A. K., Pashkevich D. D., Viter K. V. i dr. Pervoe otkry`toe issledovanie sindroma ostroj dekompensaczii serdechnoj nedostatochnosti i soputstvuyushhix zabolevanij v Rossijskoj Federaczii. Nezavisimy`j registr ORAKUL‑RF. Kardiologiya. 2015;55(5):12–21].
  10. Al‑Lawati JA, Sulaiman KJ, Al‑Zakwani I, Alsheikh‑Ali AA, Panduranga P, Al‑Habib KF et al. Systolic Blood Pressure on Admission and Mortality in Patients Hospitalized With Acute Heart Failure: Observations From the Gulf Acute Heart Failure Registry. Angiology. 2016;000331971667252. DOI:10.1177/0003319716672525.
  11. Арутюнов А. Г., Рылова А. К., Арутюнов Г. П. Регистр госпитализированных пациентов с декомпенсацией кровообращения (Павловский регистр). Сообщение 1. Современная клиническая характеристика пациента с декомпенсацией кровообращения. Клинические фенотипы пациентов. Журнал Сердечная Недостаточность. 2014;15(1):23–32 [Arutyunov A. G., Ry`lova A. K., Arutyunov G. P. Registr gospitalizirovanny`x paczientov s dekompensacziej krovoobrashheniya (Pavlovskij registr). Soobshhenie 1. Sovremennaya klinicheskaya xarakteristika paczienta s dekompensacziej krovoobrashheniya. Klinicheskie fenotipy` paczientov. Zhurnal Serdechnaya Nedostatochnost`. 2014;15(1):23–32].
  12. Фомин И. В. Хроническая сердечная недостаточность в Российской Федерации: что сегодня мы знаем и что должны делать. Российский кардиологический журнал. 2016;(8):7–13. DOI:10.15829/1560‑4071‑2016‑8‑7‑13 [Fomin I. V. Xronicheskaya serdechnaya nedostatochnost` v Rossijskoj Federaczii: chto segodnya my` znaem i chto dolzhny` delat`. Rossijskij kardiologicheskij zhurnal. 2016;(8):7–13. DOI:10.15829/1560‑4071‑2016‑8‑7‑13].
  13. Арутюнов А. Г., Драгунов Д. О., Арутюнов Г. П., Соколова А. В. Влияние величины дозы основных препаратов на риск повторных госпитализаций пациентов с хронической сердечной недостаточностью. Терапевтический архив. 2016;88(1):29–34 [Arutyunov A. G., Dragunov D. O., Arutyunov G. P., Sokolova A. V. Vliyanie velichiny` dozy` osnovny`x preparatov na risk povtorny`x gospitalizaczij paczientov s xronicheskoj serdechnoj nedostatochnost`yu. Terapevticheskij arxiv. 2016;88(1):29–34].
  14. Pocock SJ, Ariti CA, McMurray JJV, Maggioni A, Køber L, Squire IB et al. Predicting survival in heart failure: a risk score based on 39 372 patients from 30 studies. Eur Heart J. 2013;34(19):1404–13. DOI:10.1093/eurheartj/ehs337.
Polyakov D. S., Fomin I. V., Badin Yu. V., Vaysberg A. R., Valikulova F. Yu., Shechrbinina E. V. et al. Effects of systolic and diastolic blood pressure and its changes between successive hospitalizations on prognosis for patients with acute decompensated CHF. Russian Heart Failure Journal. 2017;18(3):178–184

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