By Steve Sternberg
High blood pressure, a killer when it strikes someone with a healthy heart, may be a lifesaver for someone needing hospitalization for heart failure, a study reports today.
The large-scale study found that heart failure patients whose blood pressure was low were more likely to die or end up back in the hospital than patients with higher blood pressure, the researchers report in The Journal of the American Medical Association.
“Fully one-third of these patients (with lower blood pressure) died after discharge or were readmitted,” says one author of the study, Gregg Fonarow of the University of California-Los Angeles.
The in-hospital death rate for patients whose blood pressure was a relatively low 120 when their hearts was contracting — the top number in the blood pressure reading — was much higher than for patients whose blood pressure hit 140, at 7.2% vs. 1.7%.
Patients whose hearts were able to pump more blood, measured by the ejection fraction, were just as vulnerable to low blood pressure as patients whose hearts were weaker, Fonarow says.
The findings emerged from a major effort to examine how blood pressure affects heart failure patients.
Heart failure has mainly been studied in patients who have been carefully selected for highly controlled drug trials, doctors say. Most patients in drug trials are treated outside the hospital, and they’ve been screened to make sure they don’t have other ailments, such as kidney problems.
But these studies say little about the treatment of more than 1 million patients each year who are treated in hospitals. Heart failure is the most common discharge diagnosis among patients 65 and older, the study says.
The researchers studied a registry of medical records for 48,612 patients from 259 hospitals from March 2003 to December 2004. The data came from the OPTIMIZE-HF registry sponsored by GlaxoSmithKline.
Costas Lambrew of Maine Medical Center, a member of the American College of Cardiology committee that writes treatment guidelines, called the findings “surprising” and said they raise concerns about the wisdom of prescribing medicines that lower blood pressure for heart failure patients.
Emory University’s Andrew Smith, also on the ACC committee, says the study should prompt doctors to rethink how they care for heart failure patients, perhaps monitoring those with low blood pressure more carefully.
Unfortunately, he says, the study wasn’t designed to answer treatment questions. Nor does it offer a plausible biological explanation of what’s going on, he adds, that could guide medical care and treatment decisions. (c) Copyright 2005 USA TODAY, a division of Gannett Co. Inc. <>
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