Association of Early Blood Pressure Decrease and Renal Function With Prognosis in Acute Heart Failure

2021 ◽  
Author(s):  
Yuya Matsue ◽  
Iziah E. Sama ◽  
Douwe Postmus ◽  
Marco Metra ◽  
Barry H. Greenberg ◽  
...  
Keyword(s):  
Heart Failure ◽  
Blood Pressure ◽  
Renal Function ◽  
Acute Heart Failure ◽  
Blood Pressure Decrease ◽  
Pressure Decrease

scholarly journals Early drop in systolic blood pressure and worsening renal function in acute heart failure: renal results of Pre-RELAX-AHF

2011 ◽  
Vol 13 (9) ◽  
pp. 961-967 ◽  
Author(s):  
Adriaan A. Voors ◽  
Beth A. Davison ◽  
G. Michael Felker ◽  
Piotr Ponikowski ◽  
Elaine Unemori ◽  
...  
Keyword(s):  
Heart Failure ◽  
Blood Pressure ◽  
Renal Function ◽  
Systolic Blood Pressure ◽  
Acute Heart Failure ◽  
Worsening Renal Function

P4548Early drop in systolic blood pressure and worsening renal function in the elderly acute heart failure: how does heart rate interact?

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M Takeuchi ◽  
M Nagai ◽  
K Dote ◽  
M Kato ◽  
N Oda ◽  
...  
Keyword(s):  
Heart Failure ◽  
Blood Pressure ◽  
Heart Rate ◽  
Renal Function ◽  
Systolic Blood Pressure ◽  
Acute Heart Failure ◽  
The Elderly ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Worsening Renal Function

Abstract Background Renal dysfunction is a frequent finding in patients hospitalized for acute heart failure (AHF). Worsening renal function (WRF) during hospitalization was found to be related with a poor outcome independently of baseline renal function. Early drop in systolic blood pressure (SBP) has shown to predict WRF in AHF. However, there have been few studies that reported the impact of on-admission heart rate (HR) on the relationship between early SBP drop and WRF in the elderly AHF. Purpose We assessed the hypothesis that early SBP drop predict WRF in the elderly patients with AHF, and investigated that on-admission HR might have an interaction with that relationship. Methods SBP and HR were measured on admission and 6 times during 48 hours in the 245 elderly AHF inpatients (82.9±6.0 years old, male 49.4%). WRF was defined as a serum creatinine increase of ≥0.3 mg/dL by Day 5. Early drop in SBP was calculated as the difference between admission and the lowest value measured during the first 48 hour of hospitalization. Results Early SBP drop (51.3 vs 32.5mmHg, p<0.01) and on-admission HR (79.3 vs 89.6bpm, p<0.05) were significantly different between the group with WRF (n=36) and the group without WRF (n=209). In the multiple logistic regression analysis adjusted for the confounders including age, gender, hypertension, left ventricular ejection fraction, total cholesterol, BNP, baseline creatinine, beta-blockade use, intravenous loop diuretic, isosorbide dinitrate and carperitide use, early SBP drop (OR: 1.003, 95% CI: 1.003–1.03, p<0.04) and on-admission HR (OR: 0.98, 95% CI: 0.96–0.99, p<0.01) were significantly associated with WRF. The interaction term of early SBP drop by on-admission HR did not have a significant association with WRF (p=0.3). Conclusions In the elderly AHF patients, exaggerated early SBP drop and lower on-admission HR were shown as significant independent predictors of WRF. These two factors were additively associated with WRF. Too much reduction in SBP and that in HR might be harmful to renal circulation in AHF.

Worsening Renal Function in Acute Heart Failure: Change in Blood Pressure and Effects of Relaxin

2009 ◽  
Vol 15 (6) ◽  
pp. S63
Author(s):  
G. Michael Felker ◽  
Adriaan A. Voors ◽  
Marco Metra ◽  
John R. Teerlink ◽  
Piotr Ponikowski ◽  
...  
Keyword(s):  
Heart Failure ◽  
Blood Pressure ◽  
Renal Function ◽  
Acute Heart Failure ◽  
Worsening Renal Function

scholarly journals Early Drop in Systolic Blood Pressure and Worsening Renal Function in Elderly Patients With Acute Heart Failure: How Does the Heart Rate Interact?

2020 ◽  
Author(s):  
Makoto Takeuchi ◽  
Michiaki Nagai ◽  
Keigo Dote ◽  
Masaya Kato ◽  
Noboru Oda ◽  
...  
Keyword(s):  
Heart Failure ◽  
Blood Pressure ◽  
Heart Rate ◽  
Renal Function ◽  
Systolic Blood Pressure ◽  
Acute Heart Failure ◽  
Multiple Logistic Regression Analysis ◽  
Worsening Renal Function ◽  
The Difference ◽  
Poor Outcomes

Abstract Background: Regardless of patients' baseline renal function, worsening renal function (WRF) during hospitalization is associated with poor outcomes. In individuals with acute heart failure (AHF), one predictor of WRF is an early drop in systolic blood pressure (SBP). Few studies have investigated WRF in elderly AHF patients or the influence of these patients' at-admission heart rate (HR) on the relationship between an early SBP drop SBP and the AHF. Methods: We measured the SBP and HR of 245 elderly AHF inpatients (82.9±6.0 years old, females 50.6%) at admission and another six times over the next 48 hr. We defined 'WRF' as a serum creatinine increase ≥0.3 mg/dL by Day 5 post-admission. We calculated the 'early SBP drop' as the difference between the admission SBP value and the lowest value during the first 48 hr of hospitalization. Results: There were significant differences between the 36 patients with WRF and the 209 patients without WRF: early SBP drop (51.3 vs. 32.5 mmHg, p<0.01) and at-admission HR (79.3 vs. 89.6 bpm, p<0.05), respectively. In the multiple logistic regression analysis adjusted for the confounders, early SBP drop (OR: 1.003, 95%CI: 1.003–1.03, p<0.04) and HR at-admission (OR: 0.98, 95%CI: 0.96–0.99, p<0.01) were significantly associated with WRF. No significant association was shown for the interaction term of early SBP drop ´ at-admission HR with WRF (p=0.3). Conclusions: In these elderly AHF patients, exaggerated early SBP drop and lower at-admission HR were significant independent predictors of WRF, and these factors were additively associated with WRF.

scholarly journals Levosimendan use in patients with acute heart failure and reduced ejection fraction with or without severe renal dysfunction in critical cardiac care units: a multi-institution database study

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Cze-Ci Chan ◽  
Kuang-Tso Lee ◽  
Wan-Jing Ho ◽  
Yi-Hsin Chan ◽  
Pao-Hsien Chu
Keyword(s):  
Heart Failure ◽  
Renal Function ◽  
Ejection Fraction ◽  
Acute Heart Failure ◽  
Cardiac Care ◽  
Chang Gung Memorial Hospital ◽  
Research Database ◽  
Cohort Entry ◽  
Reduced Ejection Fraction ◽  
Abnormal Renal Function

Abstract Background Acute heart failure is a life-threatening clinical condition. Levosimendan is an effective inotropic agent used to maintain cardiac output, but its usage is limited by the lack of evidence in patients with severely abnormal renal function. Therefore, we analyzed data of patients with acute heart failure with and without abnormal renal function to examine the effects of levosimendan. Methods We performed this retrospective cohort study using data from the Chang Gung Research Database (CGRD) of Chang Gung Memorial Hospital (CGMH). Patients admitted for heart failure with LVEF ≤ 40% between January 2013 and December 2018 who received levosimendan or dobutamine in the critical cardiac care units (CCU) were identified. Patients with extracorporeal membrane oxygenation (ECMO) were excluded. Outcomes of interest were mortality at 30, 90, and 180 days after the cohort entry date. Results There were no significant differences in mortality rate at 30, 90, and 180 days after the cohort entry date between the levosimendan and dobutamine groups, or between subgroups of patients with an estimated glomerular filtration rate (eGFR) ≥ 30 mL/min/1.73 m2 and eGFR < 30 mL/min/1.73 m2 or on dialysis. The results were consistent before and after propensity score matching. Conclusions Levosimendan did not increase short- or long-term mortality rates in critical patients with acute heart failure and reduced ejection fraction compared to dobutamine, regardless of their renal function. An eGFR less than 30 mL/min/1.73 m2 was not necessarily considered a contraindication for levosimendan in these patients.

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