To the Editor: In their cohort study of outcomes in patients hospitalized with acute heart failure, Dr Gheorghiade and colleagues1 showed that lower systolic blood pressure (SBP) at admission predicts worse outcomes in patients with both reduced and preserved systolic function. In their discussion, they suggested that SBP may indicate different stages or pathophysiology of heart failure, which accounts for higher mortality in patients with lower SBP.
However, the observed difference in mortality also can be explained in part by different etiologies of heart failure in each of the SBP quartiles. Whereas ischemic cardiomyopathy was more common in patients with lower SBP (50.7% for <120 mm Hg vs 39.2% for >161 mm Hg), nonischemic (ie, hypertensive) cardiomyopathy was more com-mon in those with higher SBP in the study sample (13.4% for <120 mm Hg vs 34.8% for >161 mm Hg). Because nonischemic cardiomyopathy has a more favorable prognosis than ischemic cardiomyopathy,2 patients in higher SBP quartiles might have shown lower mortality. Therefore, the relationship between SBP and mortality should be examined separately among patients with ischemic and nonischemic etiologies.
In addition, mortality is higher among patients with impaired left ventricular systolic function than among those with normal function.3 In the study sample, patients with lower SBP had lower mean left ventricular ejection fraction (LVEF) than those with higher SBP (33.3% for <120 mm Hg vs 44.4% for >161 mm Hg). Thus, it would also be worthwhile to examine the independent effect of SBP on mortality by including the variables indicative of the degree of left ventricular systolic dysfunction or stage of heart failure (such as LVEF and medications on admission) in the multivariable regression model.
Financial Disclosures: None reported.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
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