The prognostic importance of a history of hypertension in patients with symptomatic heart failure is substantially worsened by a short mitral inflow deceleration time

BMC Cardiovasc Disord. 2012 Apr 25:12:30. doi: 10.1186/1471-2261-12-30.

Abstract

Background: Hypertension is a common comorbidity in patients with heart failure and may contribute to development and course of disease, but the importance of a history of hypertension in patients with prevalent heart failure remains uncertain.

Methods: 3078 consecutively hospitalized heart failure patients (NYHA classes II-IV) were screened for the EchoCardiography and Heart Outcome Study (ECHOS). The left ventricular ejection fraction (LVEF) was estimated by 2 dimensional transthoracic echocardiography in all patients and a subgroup of 878 patients had additional data on pulsed wave Doppler assessment of transmitral flow available. A restrictive filling (RF) was defined as a mitral inflow deceleration time ≤140 ms. Patients were followed for a median of 6.8 (Inter Quartile Range 6.6-7.0) years and multivariable Cox regression models were used to assess the risk of all-cause mortality associated with hypertension.

Results: The study population had a mean age of 73 ± 11 years. 39% were female, 27% had a history of hypertension and 48% had a RF. Over the study period, 64% of the population died. Hypertension was not associated with increased risk of mortality, hazard ratio (HR) 0.95 (0.85-1.05). LVEF did not modify this relationship (p for interaction = 0.7), but RF pattern substantially influenced the outcomes associated with hypertension (p for interaction < 0.001); HR 0.75 (0.57-0.99) and 1.41 (1.08-1.84) in patients without and with RF, respectively.

Conclusions: In patients with symptomatic heart failure, a history of hypertension is associated with a substantially increased relative risk of mortality among patients with a restrictive transmitral filling pattern.

Publication types

  • Clinical Trial
  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Cardiovascular Agents / therapeutic use
  • Chi-Square Distribution
  • Comorbidity
  • Double-Blind Method
  • Echocardiography, Doppler, Pulsed
  • Female
  • Heart Failure / diagnostic imaging
  • Heart Failure / drug therapy
  • Heart Failure / mortality
  • Heart Failure / physiopathology*
  • Humans
  • Hypertension / diagnostic imaging
  • Hypertension / mortality
  • Hypertension / physiopathology*
  • Kaplan-Meier Estimate
  • Male
  • Middle Aged
  • Mitral Valve / physiopathology*
  • Multivariate Analysis
  • Predictive Value of Tests
  • Prognosis
  • Proportional Hazards Models
  • Risk Assessment
  • Risk Factors
  • Scandinavian and Nordic Countries / epidemiology
  • Stroke Volume
  • Tetrahydronaphthalenes / therapeutic use
  • Time Factors
  • Ventricular Function, Left

Substances

  • Cardiovascular Agents
  • Tetrahydronaphthalenes
  • nolomirole