scholarly journals The Impact of Glucocorticoid Therapy on Guideline-Directed Medical Treatment Titration in Patients Hospitalized for Heart Failure with Low Blood Pressure: A Retrospective Study

2021 ◽  
Vol Volume 14 ◽  
pp. 6693-6701
Author(s):  
Shuyu Li ◽  
Qingzhen Zhao ◽  
Yuzhi Zhen ◽  
Lizhuo Li ◽  
Yiqing Mi ◽  
...  
Keyword(s):  
Heart Failure ◽  
Blood Pressure ◽  
Retrospective Study ◽  
Medical Treatment ◽  
Glucocorticoid Therapy ◽  
Low Blood Pressure ◽  
The Impact

Abstract P298: The Impact of JNC VII Recommendations for Controlling Blood Pressure in a Heart Failure Disease Management Program

2011 ◽  
Vol 4 (suppl_1) ◽  
Author(s):  
George R Marzouka ◽  
Elyse Julian ◽  
Andre Dias ◽  
Leonardo Tamariz ◽  
Pat Trahan ◽  
...  
Keyword(s):  
Heart Failure ◽  
Blood Pressure ◽  
Disease Management ◽  
Pressure Control ◽  
Management Program ◽  
P Value ◽  
Baseline Visit ◽  
Heart Failure Disease Management ◽  
One Year ◽  
The Impact

Background: A significant correlation between hypertension (HTN) and long-term risk for heart failure (HF) exists. The aim of this study was (i) to assess what percent of patients enrolled in a heart failure disease management program (HFDMP) reach the JNC VII target goals for blood pressure control; (ii) to assess if there is a disparity in HTN control by race or ethnicity; (iii) and to assess the impact of reaching JNC VII targets for blood pressure control on survival. Methods: Patients with an ejection fraction ≤40% were enrolled into HFDMPs and screened for HTN, defined as blood pressure (BP) ≥ 130/80. Patients were titrated to beta blocker therapy and ace inhibitor therapy following the ACC/AHA HF guidelines. Final BP was measured after one year. Results: Mean baseline systolic BP (SBP) (N = 648) was 149.9 mmHg and mean baseline diastolic BP (DBP) was 90.5 mmHg. At one year, mean SBP decreased to 138.0 mmHg, DBP to 81.8 mmHg. There was no significant increase in survival for patients with BP ≤130 and ≤80 versus patients with HTN. There was a significant disparity in BP control in Blacks and Hispanics compared to whites (p<0.001) Conclusion: Disease management programs are an effective way to reduce BP in hypertensive patients, as well as keeping normotensive patients within JNC VII guidelines however health disparities persisted by race and ethnicity. Mean SBP and DBP of cohort at baseline Vs. 12 Month Follow up Blood pressure ≤ 130/80 mmHg Baseline Visit Last Visit P-Value SBP,m sd 110.9 (12.6%) 120.9 (22.2%) <0.001 DBP , m sd 67.1 (8.6%) 72.4 (13.7%) <0.001 Blood pressure > 130/80 mmHg Baseline Visit Last Visit P-Value SBP , m sd 149.9 (21.4%) 138.0 (24.6%) <0.001 DBP , m sd 90.5 (16.3%) 81.8 (16.8%) <0.001

Myocardial reperfusion reverses the J-curve association of cardiovascular risk and diastolic blood pressure in patients with left ventricular dysfunction and heart failure after myocardial infarction: insights from the EPHESUS trial

2020 ◽  
Vol 41 (17) ◽  
pp. 1673-1683 ◽  
Author(s):  
Michael Böhm ◽  
João Pedro Ferreira ◽  
Felix Mahfoud ◽  
Kevin Duarte ◽  
Bertram Pitt ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Blood Pressure ◽  
Diastolic Blood Pressure ◽  
Cox Regression ◽  
Cardiovascular Death ◽  
Left Ventricular ◽  
Coronary Perfusion ◽  
Increased Risk ◽  
The Impact

Abstract Aims The described association of low diastolic blood pressure (DBP) with increased cardiovascular outcomes could be due to reduced coronary perfusion or is simply due to reverse causation. If DBP is physiologically relevant, coronary reperfusion after myocardial infarction (MI) might influence DBP–risk association. Methods and results The relation of achieved DBP with cardiovascular death or cardiovascular hospitalization, cardiovascular death, and all-cause death was explored in 5929 patients after acute myocardial infarction (AMI) with impaired left ventricular function, signs and symptoms of heart failure, or diabetes in the EPHESUS trial according to their reperfusion status. Cox regression models were used to assess the impact of reperfusion status on the association of DBP and systolic blood pressure (SBP) with outcomes in an adjusted fashion. In patients without reperfusion, lower DBP &lt;70 mmHg was associated with increased risk for all-cause death [adjusted hazard ratios (HRs) 1.80, 95% confidence interval (CI) 1.41–2.30; P &lt; 0.001], cardiovascular death (HR 1.70, 95% CI 1.3–3.22; P &lt; 0.001), cardiovascular death or cardiovascular hospitalization (HR 1.54, 95% CI 1.26–1.87; P &lt; 0.001). In patients with reperfusion, the risk increase at low DBP was not observed. At low SBP, risk increased independently of reperfusion. A sensitivity analysis in the subgroup of patients with optimal SBP of 120–130 mmHg showed again risk reduction of reperfusion at low DBP. Adding the treatment allocation to eplerenone or placebo into the models had no effects on the results. Conclusion Patients after AMIs with a low DBP had an increased risk, which was sensitive to reperfusion therapy. Low blood pressure after MI identifies in patients with particular higher risk. These data support the hypothesis that low DBP in patients with stenotic coronary lesions is associated with risk, potentially involving coronary perfusion pressure and the recommendations provided by guidelines suggesting lower DBP boundaries for these high-risk patients.

Hypertonic Saline Supplemented with Furosemide is Effective in the Treatment of Heart Failure Presenting Severe Edema and Low Blood Pressure

2012 ◽  
Vol 18 (10) ◽  
pp. S167
Author(s):  
Masataka Sugahara ◽  
Miho Fukui ◽  
Shinichi Hirotani ◽  
Yoshitaka Okuhara ◽  
Daisuke Morisawa ◽  
...  
Keyword(s):  
Heart Failure ◽  
Blood Pressure ◽  
Hypertonic Saline ◽  
Low Blood Pressure

scholarly journals Impact of Self-Management Behavior on Heart Failure Patients’ Quality of Life: A Retrospective Study

2021 ◽  
Author(s):  
Eui-Young Choi ◽  
Jin-Sun Park ◽  
Deulle Min ◽  
Hye Sun Lee ◽  
Jeong-Ah Ahn
Keyword(s):  
Quality Of Life ◽  
Heart Failure ◽  
Retrospective Study ◽  
Influential Factors ◽  
Classification And Regression Tree ◽  
Self Management ◽  
Management Behavior ◽  
Heart Failure Patients ◽  
The Impact

Abstract BackgroundThe purpose of this study was to investigate the variables that significantly affect heart failure patients’ quality of life, and particularly, to identify the impact of self-management behavior on the quality of life. MethodsThis retrospective study used heart failure patients’ data from cardiovascular outpatient clinics at two tertiary medical centers in Korea. We enrolled 119 patients who completed echocardiography and stress tests and responded to questionnaires on self-management behavior and quality of life. We collected more data on general and disease-related characteristics and anthropometric and serum blood test results through electronic medical record review. We analyzed data using the classification and regression tree to explore the influencing factors and their characteristics in patients with high and low quality of life. ResultsPatients’ mean age was 74.61 years, and women represented 52.1% of the sample. It showed that the cardiac systolic function (β = 0.26, p = .013) and self-management behavior (β = 0.20, p = .048) were two major influential factors on heart failure patients’ quality of life. Therefore, HF patients’ self-management behavior is a significant modifiable factor that can improve their quality of life.ConclusionsHealthcare providers should be aware of the importance of heart failure patients’ self-management and help promote their quality of life by enhancing their self-management behavior.

scholarly journals The impact of lemon aromateraphy and breath relaxation in blood pressure on hypertensive elderly at Patukan Gamping Sleman Yogyakarta

2019 ◽  
Vol 1 (1) ◽  
pp. 9-15
Author(s):  
Ana Apriana Murtianingsih ◽  
Edy Suprayitno
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Disease ◽  
Treatment Group ◽  
Medical Treatment ◽  
Sampling Technique ◽  
P Value ◽  
Experiment Research ◽  
Heart Performance ◽  
Equivalent Control ◽  
The Impact

Hypertension is defined as the increase of chronicle blood pressure that is usually happened on elderly people. Hypertension belongs to one of Cardiovascular Disease (CVD) that becomes the cause of 80% mortality in Indonesia. One of non-pharmacological medical treatment for hypertension was by using the lemon aromatic therapy and inner relaxation breath. This therapy aims to give calming and comforting effect that leads to the decrease of heart performance and blood pressure.To find out the impact of lemon aromatic therapy and inner breath relaxation toward blood pressure on elderly people’s hypertension. This research belongs to Quasy Experiment Research Design by implementing Non Equivalent Control Groupwith one treatment group and one controlled group. This research implemented total sampling technique with 22 respondents in total. The mann-whitneystatistical analysis showed that p value 0,000 of the diastole blood pressure was at 0,016 with trustworthiness at α 0,05. There is impact of lemon aromatic therapy and inner relaxation breath toward the decrease of blood pressure on the hypertension patient. The patient of hypertension is suggested to use lemon aromatic therapy and inner relaxation breath as one of non-pharmacological medical treatment that can reduce the high blood pressure.

scholarly journals Association Between Low Blood Pressure and Clinical Outcomes in Patients With Acute Ischemic Stroke

Stroke ◽  
2020 ◽  
Vol 51 (1) ◽  
pp. 338-341
Author(s):  
Merelijne A. Verschoof ◽  
Adrien E. Groot ◽  
Jan-Dirk Vermeij ◽  
Willeke F. Westendorp ◽  
Sophie A. van den Berg ◽  
...  
Keyword(s):  
Heart Failure ◽  
Blood Pressure ◽  
Ischemic Stroke ◽  
Gastrointestinal Bleeding ◽  
Hospital Mortality ◽  
Acute Ischemic Stroke ◽  
Functional Outcome ◽  
Odds Ratio ◽  
Increased Risk ◽  
Low Blood Pressure

Background and Purpose— Low blood pressure is uncommon in patients with acute ischemic stroke (AIS). We assessed the association between baseline low blood pressure and outcomes in patients with AIS. Methods— Post hoc analysis of the PASS (Preventive Antibiotics in Stroke Study). We compared patients with AIS and low (<10th percentile) baseline systolic blood pressure (SBP) to patients with normal SBP (≥10th percentile <185 mm Hg). The first SBP measured at the Emergency Department was used. Outcomes included in-hospital mortality, major complications <7 days of stroke onset, and functional outcome at 90 days (modified Rankin scale score). We used regression analysis to calculate (common) odds ratios and adjusted for predefined prognostic factors. Results— Two thousand one hundred twenty-four out of 2538 patients had AIS. The cutoff for low SBP was 130 mm Hg (n=212; range, 70–129 mm Hg). One thousand four hundred forty patients had a normal SBP (range, 130–184 mm Hg). Low SBP was associated with an increased risk of in-hospital mortality (8.0% versus 4.2%; adjusted odds ratio [aOR], 1.58; 95% CI, 1.13–2.21) and complications (16.0% versus 6.5%; aOR, 2.56; 95% CI, 1.60–4.10). Specifically, heart failure (2.4% versus 0.1%; aOR, 17.85; 95% CI, 3.36–94.86), gastrointestinal bleeding (1.9% versus 0.1%; aOR, 26.04; 95% CI, 2.83–239.30), and sepsis (3.3% versus 0.5%; aOR, 5.53; 95% CI, 1.84–16.67) were more common in patients with low SBP. Functional outcome at 90 days did not differ (shift towards worse outcome: adjusted common odds ratio, 1.24; 95% CI, 0.95–1.61). Conclusions— Whether it is cause or consequence, low SBP at presentation in patients with AIS was associated with an increased risk of in-hospital mortality and complications, specifically heart failure, gastrointestinal bleeding, and sepsis. Clinicians should be vigilant for potentially treatable complications. Clinical Trial Registration— URL: https://www.controlled-trials.com . Unique identifier: ISRCTN66140176.

P1630Improved outcome by guideline-directed medical therapy in real-world heart failure patients despite low blood pressure and renal dysfunction

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
X Chen ◽  
U L F Dahlstrom ◽  
A Pivodic ◽  
M Fu
Keyword(s):  
Heart Failure ◽  
Blood Pressure ◽  
Ejection Fraction ◽  
Renal Dysfunction ◽  
Medical Therapy ◽  
Real World ◽  
Term Survival ◽  
Aldosterone Antagonists ◽  
All Cause Mortality ◽  
Low Blood Pressure

Abstract Background Among patients with heart failure and reduced ejection fraction (HFrEF), angiotensin-converting enzyme inhibitors (ACEI/ARB), β-adrenergic receptor blockers (BB) and aldosterone antagonists (AA) are guideline-directed medical therapy (GDMT) to improve prognosis and well-being. However, low blood pressure (BP) and renal dysfunction are often challenges and barriersof the clinical implementation in real-world. Purpose To investigate whether it is beneficial to apply GDMT in real-world patients with HFrEF despite low blood pressure and renal dysfunction. Methods This study initially included 51060 HF patients from the Swedish Heart Failure Registry. After the exclusion of patients with ejection fraction ≥40% (53.4%), systolic BP>100mmHg (40.0%), eGFR>45ml/min/1.73m2 (3.3.%) and those died during hospitalization (0.3%), 1386 patients were ultimately enrolled in this study. Patients were grouped into five subgroups (ACEI/ARB+BB+AA, ACEI/ARB+BB, ACEI/ARB+AA, ACEI/ARB and BB). Outcome is all cause mortality. Results Among the study patients, 485 (35.0%) were treated with ACEI/ARB+BB+AA, 672 (48.5%) with ACEI/ARB+BB, 41 (3.0%) with ACEI/ARB+AA, 68 (4.9%) with ACEI/ARB and 120 (8.7%) with BB. Patients in ACEI/ARB+BB+AA group were younger (72.9±9.7 vs. 76.1±9.2 vs. 73.9±9.7 vs. 79.5±8.0 vs. 79.3±8.9), with higher BMI (25.4±4.5 vs. 25.5±4.7 vs. 23.7±4.2 vs. 23.4±3.8 vs. 24.7±6.3), more in NYHA I/II (30.8% vs. 33.3% vs. 1.7% vs. 18.9% vs. 24.3%). During the follow-up, all cause mortality was lowest in patients treated with ACEI/ARB+BB+AA (59% vs. 60.4% vs. 75.6% vs. 75% vs. 79.2%). After adjustement for age and gender, when compared with the ACEI/ARB+BB+AA group, the hazard ratio for ACEI/ARB+BB is 1.05 (0.91–1.23), ACEI/ARB+AA 1.16 (0.80–1.68), ACEI/ARB 1.51 (1.11–2.04), and BB 2.36 (1.86–2.98) respectively Conclusions In real-world HFrEF patients with low blood pressure and renal dysfunction, full medication of GDMT is associated with improved long-term survival.

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