The relationship between systolic blood pressure on admission and mortality in older patients with heart failure

To determine the relationship between admission systolic blood pressure (SBP) and mortality in older patients hospitalized for heart failure (HF) and among various subgroups. We evaluated the independent association between initial SBP and 30-day and 1-year mortality, and potential interactions by age, gender, race, previous hypertension, and left ventricular dysfunction using multivariable logistic regression in the National Heart Failure Project, a database of Medicare patients > 65 years old recruited from 1998 through 2001. Among 56 942 patients, mean admission SBP was 147.0 +/- 92.3 mmHg, 15% presenting with SBP > 180 mmHg. Systolic blood pressure showed an inverse relationship with 30-day and 1-year mortality rates in all subgroups analysed. Using admission SBP of 120-149 mmHg as the reference, the adjusted odds ratios (95% confidence intervals) for 1-year mortality were 2.18 (1.77-2.69) for SBP < 90 mmHg, 1.57 (1.47-1.69) for SBP 90-119 mmHg, 0.71 (0.67-0.76) for SBP 150-179 mmHg, 0.63 (0.57-0.68) for SBP 180-209 mmHg, and 0.51 (0.44-0.59) for SBP >= 210 mmHg. Higher SBP on admission is associated with significant lower 30-day and 1-year mortality in patients hospitalized for HF. The relationship is strong, graded, independent of other clinical factors and consistent among subgroups.