Arterial Pulse Pressure and Outcomes in Heart Failure

Study Questions:

What is the association between pulse pressure (PP) and adverse outcomes at 1 year in patients hospitalized for heart failure (HF)?


The investigators conducted a retrospective cohort study from clinical registry data linked to Medicare claims for 40,421 HF patients entered in the Get With the Guidelines-HF program. Cox proportional hazards models were used to estimate the association between discharge PP and all-cause mortality and the composite outcome of all-cause mortality/ readmission by 1 year.


A nonlinear association between PP and mortality (expressed as hazard ratio [HR] per 10 mm Hg increase in PP) was observed in patients with HF and reduced (<0.40) ejection fraction (HFrEF). Risk decreased as PP increased up to 50 mm Hg (adjusted HR, 0.946; 95% confidence interval [CI], 0.900-0.995; p = 0.03). When PP was ≥50 mm Hg, risk increased as PP increased (adjusted HR, 1.091; 95% CI, 1.050-1.135; p < 0.001). In patients with HF and preserved EF (HFpEF) (≥0.40), there was a significant association between PP and mortality with risk increasing as PP increased, although the magnitude of the risk was significantly impacted by systolic blood pressure (SBP). Qualitatively similar observations were obtained for the composite outcome and use of EF ≥0.50 to define HFpEF.


The authors concluded that association between PP at hospital discharge and 1-year outcomes is a function of HF phenotype, SBP, and absolute PP.


This analysis reports that arterial PP at the time of hospital discharge in over 40,000 patients ≥65 years of age with a principal discharge diagnosis of HF was significantly associated with adverse outcomes at 1 year. A nonlinear association was observed in HFrEF patients such that, at PP <50 mm Hg, risk increases with decreasing PP and that at PP ≥50 mm Hg, risk increases with increasing PP. In HFpEF patients, risk increases with increased PP, and the magnitude of the association is significantly impacted by SBP. It appears that proper interpretation of PP in HF patients requires an understanding of the hemodynamic determinants of PP and the clinical characteristics of the patient.

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