In our previous study, a J-shaped curve relationship was observed between sitting blood pressure (BP) and long term prognosis in patients with cardiac disease; the patients with sitting systolic BP (SBP) 115–125 mmHg had best prognosis. In the present analysis, we tried to examine prognostic factors in patients with SBP <115 mmHg.Design and Method:
Eighty-nine consecutive cases (78 patients; age, 79 ± 12 y; male 47%) who discharged after cardiac rehabilitation and whose sitting SBP at discharge was <115 mmHg were studied. The causes of index hospitalizations were as follows; acute worsening of heart failure, n = 62: acute myocardial infarction, n = 20: rehabilitation after cardiovascular (CV) operation, n = 4: acute aortic dissection, n = 1. Two-year prognostic factors for composite events (admission due to CV disease and all-cause death) were investigated. The follow-up periods were 2–731 days (mean, 388 days).Results:
Fifty composite events (admission due to CV diseases, 41: all-cause death, 9) occurred. Supine SBP and sitting SBP of the patient group with the events (E group) and without them (nonE group) were comparable. The decline of SBP from supine to sitting position (ΔSBP) was greater in the E group than that in the nonE group (12 ± 15 mmHg, 5 ± 9 mmHg, respectively, p = 0.01). Receiver operating characteristics curve analysis revealed that 13.3 mmHg was the optimal cut-off point of ΔSBP to predict the composite event (area under curve, 0.641). Age, eGFR, left ventricular mass index, and ΔSBP ≥ 13.3 mmHg were the significant prognostic factors for the composite events in the Cox proportional hazards model including significant factors in univariate comparisons.Conclusions:
The ΔSBP was a significant prognostic factor in patients with cardiac diseases and low BP, suggesting that the ΔSBP may be an indicator of excessive lowering of BP for these patients.