© 2007 European Society of Cardiology
Acute heart failure associated with high admission blood pressure — A distinct vascular disorder?
a Duke University Medical Center and the Duke Clinical Research Institute USA
b The University of North Carolina Chapel Hill, North Carolina, USA
c Assaf-Harofeh Medical Center Zerifin Israel
* Corresponding author. Duke Clinical Research Institute, 2400 Pratt St., Durham NC, 27515, USA. E-mail address: cotte013{at}mc.duke.edu
 |
Abstract |
|---|
Background: Although blood pressure (BP) is elevated in patients with acute heart failure (AHF), first admission BP has not been meticulously recorded before treatment in previous studies.
Methods: During three consecutive months, all AHF admissions (335 patients) to a city hospital which provides the sole inpatient medical service for approximately 500,000 people were registered. First BP was recorded before treatment at the first patient encounter in the ambulance or the emergency room.
Results: Mean BP at admission was 164±38/88±22 mm Hg. Mean BP in the highest quartile was 212±22/115±13 mm Hg. Patients with higher baseline BP had higher ejection fraction (highest versus lowest quartile 48±13% vs. 33±14%, p<0.001), less atrial fibrillation (18% vs. 42%, p=0.001) as well as lower mean urea and higher mean haemoglobin. The apparently more favourable baseline characteristics in patients with higher admission BP did not translate into lower morbidity – the rate of worsening heart failure – was not related to admission BP. However, 6 month mortality was lower in patients with higher admission BP (4% vs. 19.3%, p=0.002).
Conclusions: Blood pressure is elevated substantially at the onset of AHF. The different characteristics and outcome of patients admitted with high-BP associated AHF suggest that this presentation may be a specific disorder related to a distinct yet unknown pathophysiological mechanism.
Key Words: Acute heart failure • Blood pressure • Hypertension
Received February 7, 2006; Revised April 28, 2006; Accepted June 14, 2006