According to this study:

* Systolic blood pressure helps predict outcomes in patients hospitalized for heart failure with either reduced or relatively preserved systolic function.

* Low systolic blood pressure (less than 120 mmHg) in such patients indicates a poor prognosis even with medical therapy.

To examine the relationship between systolic blood pressure at hospital admission and mortality rates in the general heart failure population (as opposed to patients selected for clinical trials), researchers conducted a cohort study using data from the Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure (OPTIMIZE-HF), a registry database "designed to evaluate the use of evidence-based, guideline-recommended therapy in patients hospitalized for heart failure and to improve the quality of care provided to these patients." (This study is the first report based on data from OPTIMIZE-HF.)

Patients in the registry were hospitalized with heart failure at one of 259 U.S. facilities between March 2003 and December 2004. They were divided into quartiles according to systolic blood pressure at hospital admission (less than 120, 120 to 139, 140 to 161, and greater than 161 mmHg); in-hospital outcomes were based on 48,612 patients 18 years of age or older with heart failure. Of the 41,267 patients in whom left ventricular function was assessed, 51% had preserved systolic function. Postdischarge outcomes were determined using a subgroup of 5,791 patients, with follow-up performed at 60 to 90 days after discharge.

The in-hospital mortality rate in each systolic blood pressure quartile was 7.2% (less than 120 mmHg), 3.6% (120 to 139 mmHg), 2.5% (140 to 161 mmHg), and 1.7% (greater than 161 mmHg). Patients with lower systolic blood pressure "need to be more closely monitored with additional efforts by physicians and nurses to ensure that recommended therapies for heart failure such as angiotensin-converting enzyme inhibitors and [beta]-blockers are initiated prior to hospital discharge," said study coauthor Gregg Fonarow of the Ahmanson-UCLA Cardiomyopathy Center at UCLA Medical Center, who also noted that patients with higher systolic blood pressure have a better prognosis, can be hospitalized with less intensive monitoring, and should receive treatment to bring their blood pressure within normal range as soon as possible.

Postdischarge mortality rates in the follow-up cohort, according to systolic blood pressure at admission, were 14%, 8.4%, 6%, and 5.4%, respectively. However, Fonarow said that all patients discharged from the hospital with heart failure should receive more frequent outpatient follow-up or be referred to multidisciplinary heart failure disease management programs.

HL