• Mohammed Yousufuddin, Zeliang Ma, Ebrahim Barkoudah, Muhammad Waqas Tahir, Meltiady Issa, Zhen Wang, Fatmaelzahraa Badr, Ibrahim A Gomaa, Sara Aboelmaaty, Ahmed A Al-Anii, Sarah L Gerard, Ahmed D Abdalrhim, Sumit Bhagra, Arshad Jahangir, Rehan Qayyum, Gregg C Fonarow, and Mohamad H Yamani.
• Department of Hospital Internal Medicine, Mayo Clinic Health System, Austin, MN, USA. Electronic address: yousufuddin.mohammed@mayo.edu.
• Eur. J. Intern. Med. 2024 Oct 21.

BackgroundOptimal systolic blood pressure (SBP) targets for the treatment of hospitalized acute decompensated heart failure (ADHF) patients are not known.ObjectivesTo investigate the association between SBP <130 mmHg at discharge or within 30 days and all-cause mortality or years of life lost (YLL) after ADHF hospitalization.MethodsWe analyzed medical records of 14,611 adults who survived ADHF hospitalization at 17 hospitals (2010-2022) with follow-up until May 2023. Sensitivity analysis included 10,515 patients with post-discharge SBP measured within 30 days.ResultsMortality rates at 30 days, 180 days, 1 year, and 3 years were higher in patients with discharge SBP <130 mmHg (6.9 %, 21.1 %, 29.1 %, and 45.1 %) vs. SBP ≥130 mmHg (4.8 %, 16.0 %, 23.6 %, and 40.3 %). Hazard ratios (HR) for mortality were consistently higher in patients with discharge SBP <130 at 1.30 (95 % CI, 1.11-1.52), 1.45 (95 % CI, 1.33-1.58), 1.40 (95 % CI, 1.30-1.51), 1.31 (95 % CI, 1.23-1.38) at these intervals. The average YLL per deceased individual was 1-2 years greater in the discharge SBP <130 group (incidence rate ratios, 1.004 to 1.230). Restricted cubic spline analysis showed that HR for mortality shifted toward better outcomes at discharge SBP ≥130 Sensitivity analysis supported these findings.ConclusionIn hospitalized ADHF patients, SBP <130 mmHg at discharge or within 30 days post-discharge was linked to higher mortality and YLL, while SBP ≥130 mmHg or improvement to ≥130 mmHg post-discharge led to better short and long-term outcomes. Further research is needed to understand the mechanisms and benefits of SBP optimization.Copyright © 2024 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.

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