Early drop in systolic blood pressure, heart rate at admission, and their effects on worsening renal function in elderly patients with acute heart failure

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.

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

10.21203/rs.3.rs-23069/v1 ◽

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.

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

European Journal of Heart Failure ◽

10.1093/eurjhf/hfr060 ◽

2011 ◽

Vol 13 (9) ◽

pp. 961-967 ◽

Cited By ~ 75

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

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Usefulness of systolic blood pressure combined with heart rate measured on admission to identify 1-year all-cause mortality risk in elderly patients firstly hospitalized due to acute heart failure

Aging Clinical and Experimental Research ◽

10.1007/s40520-019-01153-2 ◽

2019 ◽

Vol 32 (1) ◽

pp. 99-106

Author(s):

Rafael Moreno-González ◽

Francesc Formiga ◽

Jose María Mora Lujan ◽

David Chivite ◽

Albert Ariza-Solé ◽

...

Keyword(s):

Heart Failure ◽

Blood Pressure ◽

Heart Rate ◽

Elderly Patients ◽

Systolic Blood Pressure ◽

Acute Heart Failure ◽

Mortality Risk ◽

All Cause Mortality

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Predictors of Mortality by Sex and Race in Heart Failure With Preserved Ejection Fraction: ARIC Community Surveillance Study

Journal of the American Heart Association ◽

10.1161/jaha.119.014669 ◽

2020 ◽

Vol 9 (19) ◽

Author(s):

Kavita Sharma ◽

Yejin Mok ◽

Lucia Kwak ◽

Sunil K. Agarwal ◽

Patricia P. Chang ◽

...

Keyword(s):

Heart Failure ◽

Blood Pressure ◽

Heart Rate ◽

Renal Function ◽

Ejection Fraction ◽

Surveillance Study ◽

Preserved Ejection Fraction ◽

Predictors Of Mortality ◽

Worsening Renal Function ◽

Increased Risk

Background Heart failure with preserved ejection fraction (HFpEF) accounts for half of heart failure hospitalizations, with limited data on predictors of mortality by sex and race. We evaluated for differences in predictors of all‐cause mortality by sex and race among hospitalized patients with HFpEF in the ARIC (Atherosclerosis Risk in Communities) Community Surveillance Study. Methods and Results Adjudicated HFpEF hospitalization events from 2005 to 2013 were analyzed from the ARIC Community Surveillance Study, comprising 4 US communities. Comparisons between clinical characteristics and mortality at 1 year were made by sex and race. Of 4335 adjudicated acute decompensated heart failure cases, 1892 cases (weighted n=8987) were categorized as HFpEF. Men had an increased risk of 1‐year mortality compared with women in adjusted analysis (hazard ratio [HR], 1.27; 95% CI, 1.06–1.52 [ P =0.01]). Black participants had lower mortality compared with White participants in unadjusted and adjusted analyses (HR, 0.79; 95% CI, 0.64–0.97 [ P =0.02]). Age, heart rate, worsening renal function, and low hemoglobin were associated with increased mortality in all subgroups. Higher body mass index was associated with improved survival in men, with borderline interaction by sex. Higher blood pressure was associated with improved survival among all groups, with significant interaction by race. Conclusions In a diverse HFpEF population, men had worse survival compared with women, and Black participants had improved survival compared with White participants. Age, heart rate, and worsening renal function were associated with increased mortality across all subgroups; high blood pressure was associated with decreased mortality with interaction by race. These insights into sex‐ and race‐based differences in predictors of mortality may help strategize targeted management of HFpEF.

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