Background:
Effects of pulse pressure and benefits of blood pressure lowering with intravenous anti-hypertensive medications and beta-blockers in CVA patients have not been well investigated.
Material and Methods:
Demographic, clinical, and echocardiographic data were collected and long-term outcomes (55+/-21 months) were ascertained in 356 consecutive cerebro-vascular accident (CVA) patients. ANOVA, chi-square, Kaplan-Meier, and logistic regression tests were employed. Study was approved by the institutional IRB.
Results:
Widened pulse pressure on admission was significantly elevated in CVA patients who expired in the hospital or during the long-term follow-up (62+/-21mmHg for long-term survivors vs. 72+/-20mmHg for hospital deaths vs. 69+/-28 mmHg for long-term deaths, p=0.01). There was a trend towards increased hospital mortality (14% in long-term survivors vs. 25% in hospital deaths vs. 22% in long-term deaths, p=0.110) in CVA patients requiring IV anti-hypertensive therapy. Utilization of beta-blockers was lower in patients who suffered hospital death, but more likely in patients experiencing long-term death (42% use in hospital deaths vs. 48% in long-term survivors vs. vs. 66% in long-term deaths, p=0.003). Beta-blocker use was not predictive of hospital outcomes but was strongly predictive of adverse event long-term events (HR 2.1, 95%CI 1.3-3.4, p=0.002). When adjusted for demographic parameters and co-morbidities in multivariate analysis, pulse pressure and IV anti-hypertensive therapy were not predictive of short or long-term outcomes, while beta-blocker treatment was associated with reduced hospital (0.3, 95%CI 0.1-0.9, p=0.029) but not long-term mortality.
Conclusions:
Widened pulse pressure and need for IV anti-hypertensive therapy are not predictive of adverse short- or long-term outcomes when demographics and co-morbidities are accounted for. Effects of beta-blocker therapy on outcomes in CVA patients are complex. Wider beta-blocker use in acute CVA may be associated with better hospital outcomes, while increased long term mortality with beta-blocker therapy may be indicative of poor cardiovascular health leading to adverse outcomes
Pre-Operative Pulmonary Hypertension Does Impact Long Term Outcomes Following Heart Transplantation: Review of the United Network for Organ Sharing Database
