NEW YORK (Reuters Health) – In patients with chronic heart failure, higher systolic blood pressures paradoxically predict better survival, according to researchers in the UK.
Writing in the January issue of Heart, Dr. Claire E. Raphael and colleagues at St. Mary’s Hospital and Imperial College, London note that because “blood pressure is intrinsically related to the heart’s ability to pump….there is a strong case for blood pressure as a marker of prognosis in heart failure.”
The researchers performed a meta-analysis of 10 published reports on the relationship between blood pressure and mortality in chronic heart failure. Altogether, the studies involved 8088 patients and 29,222 person-years of follow-up.
In all 10 papers, a higher systolic blood pressure was a favorable prognostic marker, according to the article.
“The decrease in mortality rates associated with a 10 mm Hg higher systolic blood pressure was 13.0%...in the heart failure population,” the authors report. This effect was not related to etiology or to the use of beta blockers or angiotensin enzyme-converting inhibitors.
Dr. Raphael and her coauthors point out that in patients with cardiac disease but without chronic heart failure affecting systolic function, mean arterial blood pressure is largely determined by peripheral vasoconstriction, and higher systolic pressure indicates poor elasticity of the arteries.
In patients with heart failure, however, systolic pressure reflects the ejection fraction and cardiac output. “Therefore,” the investigators write, “a higher blood pressure is associated with a decreased mortality as it serves as an indirect measure of cardiac function.”
“The potential of this simple variable in outpatient assessment of patients with chronic heart failure should not be neglected,” the authors conclude. In particular, they say, the information could be used to optimize cardiac resynchronization devices.
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