Quantifying the paradoxical effect of higher systolic blood pressure on mortality in chronic heart failure
Claire E Raphael 1*, Zachary Ian Whinnett 2, Justin Davies 1, Marianna Fontana 1, Christopher J C Johnston 3, Emily Ferenczi 1, Charlotte H Manisty 1, Jamil Mayet 4 and Darrel P Francis 1
1 Imperial College, United Kingdom
2 Imperial College London and St Mary's Hospital, United Kingdom
3 Imperial College London, United Kingdom
4 International Centre for Circulatory Health, St Mary's Hospital/Imperial College, United Kingdom
* To whom correspondence should be addressed. E-mail: claire.raphael{at}gmail.com.
Accepted 13 May 2008
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Background: Although higher blood pressures are generally recognised to be an adverse prognostic marker in risk assessment of cardiology patients, its relationship to risk in chronic heart failure (CHF) may be different. We set out to examine systematically the published literature on the relationship between blood pressure and mortality in CHF.
Methods: We used Medline and EMBASE to identify studies that gave a hazard or relative risk ratio for systolic blood pressure in a stable chronic heart failure population. Included studies were analysed to obtain a unified hazard ratio and quantify the degree of confidence.
Results: 10 studies met the inclusion criteria, giving a total population of 8088, with 29222 person-years of follow up. All studies showed that a higher systolic blood pressure was a favourable prognostic marker in chronic heart failure, in contrast to the general population where it is an indicator of poorer prognosis. The decrease in mortality rates associated with a 10 mmHg higher SBP was 13% (95% CI 10%-15%) in the heart failure population. This was not related to aetiology, ACE inhibitor or â blocker use.
Conclusion: Systolic blood pressure is an easily-measured, continuous variable that has a remarkably consistent relationship with mortality within the chronic heart failure population. We should not neglect the potential of this simple variable in outpatient assessment of patients with chronic heart failure. One possible application of this information is in the optimization of cardiac resynchronization devices.
