Although elevated blood pressure (BP) is an important factor causing acute decompensated heart failure (HF), the underlying pathophysiology of hypertensive HF remains unclear. Here we compared the prognostic factors for one-year mortality between patients with hypertensive and nonhypertensive acute decompensated HF.Design and method:
We retrospectively studied 436 consecutive patients with acute decompensated HF. Hypertensive HF was defined as an elevated BP of greater than or equal to 140/ mmHg and/or /90 mmHg at admission. Potential risk factors for one-year mortality were identified by univariate analyses; then multivariate Cox regression analysis with backward stepwise selection was performed with variables showing a statistical value of P < 0.10 in the univariate analyses.Results:
Of the entire study cohort, 49% had hypertensive and 51% had nonhypertensive HF. One-year mortality was 9.6% (42 deaths). Patients with hypertensive HF exhibited a significantly lower one-year mortality than those with nonhypertensive HF (log-rank, P = 0.005). In the hypertensive HF group, age [hazard ratio (HR), 1.14; 95% confidence interval (CI), 1.03–1.25; P = 0.007], lower serum sodium value at admission (serum sodium value: HR, 0.64; 95% CI, 0.49–0.83; P = 0.001), and higher mitral E/E’ ratio determined by echocardiogram (HR, 1.39; 95% CI, 1.11–1.74; P = 0.004) were independent risk factors for one-year mortality. In contrast, age (HR, 1.09; 95% CI, 1.03–1.15; P = 0.002), lower systolic BP at admission (systolic BP: HR, 0.96; 95% CI, 0.93–0.99; P = 0.009), higher serum creatinine level at admission (HR, 1.76; 95% CI, 1.21–2.55; P = 0.003), and medication without diuretics at discharge (HR, 4.27; 95% CI, 1.80–10.12; P = 0.001) were independent risk factors for one-year mortality in the nonhypertensive HF group.Conclusions:
There were significant differences in the prognostic factors for one-year mortality between the hypertensive and nonhypertensive HF groups. Renal impairment at admission significantly associated with one-year mortality only in the nonhypertensive HF group. E/E’ was a reliable predictor of mortality only in the hypertensive HF group. Elucidation of the mechanisms behind these findings could lead to more effective therapeutic strategies for patients with HF.