Lower admission blood pressure is an independent predictor of one-year mortality in elderly patients experiencing a first hospitalization because of acute heart failure.

BACKGROUND: Systolic blood pressure (SPB) is an acknowledged prognostic factor in heart failure (HF) patients. Admission SBP should be a risk factor for one-year mortality even in elderly patients experiencing a first admission for HF, and this risk may persists in the oldest subset of patients.

DESIGN: Methods: We reviewed the medical records of 1031 patients aged 70 or older admitted within a three-year period because of a first episode of acute heart failure (AHF). The cohort was divided according to admission SBP values in quartiles. We analyzed all-cause mortality as a function of these admission SBP quartiles.

RESULTS: Mean age was 82.2 ± 6 years; their mean admission SBP was 138.6 ± 25 mm Hg. A statistically significant association was present between mortality at 30 (p<0.0001), 90 (p<0.0001) and 365 days (p<0.0001) after hospital discharge and lower admission SBP quartiles. One-year mortality ranged from 14.7% for patients within the upper SBP quartile to 41.4% for those in the lowest quartile. The multivariate analysis confirmed this association (HR 0.884; CI 95%: 0.615-0.76; P=0.0001) which remained significant when admission SBP was evaluated as a continuous variable (HR 0.980; CI 95%: 0.975-0.985; p=0.0001). The association between SBP and one-year mortality remained when sample was divided into old (70 - 82) and "oldest-old" (>82 years) patients.

CONCLUSIONS: Lower SBP at admission is an independent predictor of mid-term post-discharge mortality for elderly patients experiencing a first admission for AHF.