Rate pressure product and the components of heart rate and systolic blood pressure in hospitalized heart failure patients with preserved ejection fraction: Insights from ASCEND-HF

Abstract

Background: Heart rate and systolic blood pressure (SBP) are prognostic markers in heart failure (HF) with reduced ejection fraction (HFrEF). Their combination in rate pressure product (RPP) as well as their role in heart failure with preserved ejection fraction (HFpEF) remains unclear.

Hypothesis: RPP and its components are associated with HFpEF outcomes.

Methods: We performed an analysis of Acute Study of Clinical Effectiveness of Nesiritide in Subjects With Decompensated Heart Failure (ASCEND-HF; http://www.clinicaltrials.gov NCT00475852), which studied 7141 patients with acute HF. HFpEF was defined as left ventricular ejection fraction ≥40%. Outcomes were assessed by baseline heart rate, SBP, and RPP, as well as the change of these variables using adjusted Cox models.

Results: After multivariable adjustment, in-hospital change but not baseline heart rate, SBP, and RPP were associated with 30-day mortality/HF hospitalization (hazard ratio [HR]: 1.17 per 5-bpm heart rate, HR: 1.20 per 10-mm Hg SBP, and HR: 1.02 per 100 bpm × mm Hg RPP; all P < 0.05). Baseline SBP was associated with 180-day mortality (HR: 0.88 per 10-mm Hg, P = 0.028). Though change in RPP was associated with 30-day mortality/HF hospitalization, the RPP baseline variable did not provide additional associative information with regard to outcomes when compared with assessment of baseline heart rate and SBP variables alone.

Conclusions: An increase in heart rate and SBP from baseline to discharge was associated with increased 30-day mortality/HF hospitalization in HFpEF patients with acute exacerbation. These findings suggest value in monitoring the trend of vital signs during HFpEF hospitalization.

Keywords: Blood Pressure Control and Regulation; Clinical Trials; Heart Failure.

Conflict of interest statement

Robert J. Mentz receives research support from Amgen, AstraZeneca, Bristol‐Myers Squibb, GlaxoSmithKline, Gilead, Novartis, Otsuka, and ResMed; and has received honoraria from HeartWare, Janssen, Luitpold Pharmaceuticals, Inc., Novartis, ResMed, and Thoratec/St. Jude. He has served on an advisory board for Luitpold Pharmaceuticals, Inc. The authors declare no other potential conflicts of interest.

© 2018 Wiley Periodicals, Inc.

Figures

Figure 1

Kaplan–Meier event curve for 180‐day all‐cause mortality in HFpEF patients by baseline SBP, with number at risk at 30‐day intervals from randomization by SBP. Abbreviations: HFpEF, heart failure with preserved ejection fraction; SBP, systolic blood pressure