Systolic hf
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Systolic Heart Failure: Clinical Insights and Prognostic Factors
Introduction to Systolic Heart Failure
Systolic heart failure (HF) is characterized by the heart's inability to pump blood effectively due to weakened ventricular contraction, often measured by a reduced ejection fraction (EF). This condition is associated with various clinical outcomes and prognostic factors, including systolic blood pressure (SBP), which plays a crucial role in the management and prognosis of HF patients.
Prognostic Value of Systolic Blood Pressure in Heart Failure
Low Systolic Blood Pressure and Adverse Outcomes
Low SBP is a significant predictor of adverse outcomes in patients with heart failure with reduced ejection fraction (HFrEF). Research from the EVEREST trial indicates that lower SBP at baseline and discharge is associated with increased all-cause mortality (ACM) and cardiovascular mortality or heart failure hospitalization (CVM + HHF). Specifically, a 10-mm Hg decrease in SBP was linked to a 15% increase in ACM and a 9% increase in CVM + HHF.
Systolic Blood Pressure and Long-Term Outcomes
In patients with chronic mild to moderate HF, baseline SBP ≤ 120 mm Hg was associated with higher cardiovascular and HF mortalities, as well as increased all-cause, cardiovascular, and HF hospitalizations. This highlights the importance of maintaining optimal SBP levels to improve long-term outcomes in HF patients.
J-Curve Relationship Between SBP and Heart Failure Readmission
A study investigating the association between SBP and long-term clinical outcomes found a J-curve relationship between SBP and HF readmission, with the lowest risk observed at an SBP around 130 mm Hg. Both low (<110 mm Hg) and high (≥150 mm Hg) SBP were associated with increased risks of HF readmission and all-cause death.
Systolic-Diastolic Hypertension and Heart Failure
Comparison with Isolated Systolic Hypertension
Both systolic-diastolic hypertension (SDH) and isolated systolic hypertension (ISH) are significant risk factors for incident HF and cardiovascular mortality in older adults. The Cardiovascular Health Study found that individuals with SDH and ISH had similar associations with incident HF and cardiovascular mortality, with hazard ratios indicating nearly double the risk compared to those without hypertension.
Heart Failure with Preserved Systolic Function
Clinical Characteristics and Outcomes
Heart failure with preserved systolic function (HF-PSF) is common, particularly among older adults and women. Patients with HF-PSF often have a nonischemic etiology and are less symptomatic compared to those with reduced systolic function . Despite a lower in-hospital mortality risk, HF-PSF patients have similar post-discharge mortality and rehospitalization rates as those with reduced systolic function .
Impact of Low Blood Pressure in HF-PSF
Low SBP is also a risk factor for adverse outcomes in elderly patients with HF-PSF. Studies suggest that female elders with preserved systolic function often present with less classic symptoms of HF and are less likely to receive cardiology consultations, underscoring the need for tailored management strategies.
Conclusion
Systolic blood pressure is a critical factor in the prognosis and management of heart failure, influencing both short-term and long-term outcomes. Maintaining optimal SBP levels is essential to reduce mortality and hospitalization rates in HF patients. Additionally, the unique characteristics and risks associated with HF-PSF highlight the need for more effective and individualized treatment approaches. Further research is necessary to refine management strategies and improve outcomes for all HF patients.
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