Early drop in systolic blood pressure is associated with poor diuretic response and prognosis in patients with acute heart failure.

Aims: Although an excessive drop in systolic blood pressure (SBP) during acute heart failure (AHF) negatively impacts prognosis, the association between changes in SBP and the diuretic response (DR) is unclear. We aimed to clarify the association between an early drop in SBP and DR/prognosis in patients with AHF.
Methods and Results: This was a sub-analysis of the REALITY-AHF study, which registered patients with AHF admitted through emergency departments (EDs). An early SBP drop was defined as the difference between baseline SBP and the lowest value during the first 48 h of hospitalization. DR was defined as the urine output achieved per 40 mg of intravenous furosemide administered. SBP was measured on admission, at 90 min, and 6, 24, and 48 h after admission. Patients were divided into four groups according to their median SBP drop and DR: greater SBP drop/poor DR (n = 322), smaller SBP drop/poor DR (n = 409), greater SBP drop/good DR (n = 419), and smaller SBP drop/good DR (n = 314). The study included 1,464 patients. A greater SBP drop/poor DR was associated with higher baseline SBP and vasodilator use. Multivariable linear regression analysis showed that a greater drop in SBP was associated with poorer DR following adjustment for potential covariates. Cox proportional hazards analysis demonstrated that a greater SBP drop/poor DR was independently associated with 1-year mortality. Both SBP and DR changes were independently associated with prognosis.
Conclusion: An early drop in SBP during the first 48 h of hospitalization was associated with poor DR and 1-year mortality in patients with AHF.
Clinical Trial Registration: URL: http://www.umin.ac.jp/ctr/Unique identifier: UMIN000014105.
Competing Interests: Conflict of interest: K.K. received an honorarium from Daichi Sankyo Co., Ono Pharmaceutical Co., Ltd., AstraZeneca, Otsuka Pharmaceutical Co., Ltd., and Novartis Pharmaceuticals Co., Ltd. T.O. has received research grants from Ono Pharmaceutical Co., Ltd., Bayer Pharmaceutical Co., Ltd., Daiichi-Sankyo Pharma Inc., and Amgen Astellas BioPharma. T.O. received honorariums from Novartis Pharma, Ono Pharmaceutical Co., Ltd., Otsuka Pharmaceutical Co., Ltd., and Medtronic Japan Co., Ltd. N.K. is affiliated with a department funded by Philips Healthcare; Asahi KASEI Corporation; Inter Reha Co., Ltd; and Toho Holdings Co., Ltd based on collaborative research agreements, and receives a research grant from EchoNous Inc. Y.M. is affiliated with a department endowed by Philips Respironics, ResMed, Teijin Home Healthcare, and Fukuda Denshi, and has received an honorarium from Otsuka Pharmaceutical Co. and Novartis Japan. The other authors have no other conflicts of interest to declare.
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