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Prognostic value of blood pressure in ambulatory heart failure: a meta-analysis and systematic review. Ambulatory blood pressure predicts heart failure prognosis

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Abstract

Previous primary studies have explored the association between blood pressure (BP) and mortality in ambulatory heart failure (HF) patients reporting varying and contrasting associations. The aim is to determine the pooled BP prognostic value and explore potential reasons for between-study inconsistency. We searched Medline, Cochrane, EMBASE and CINAHL from January 2005 to October 2018 for studies with ≥ 50 events (mortality and/or hospitalization) and included BP in a multivariable model in ambulatory HF patients. We pooled hazard ratios (random effects model) for systolic BP (SBP) or diastolic BP (DBP) effect on mortality and/or hospitalization risk. We used a priori defined sub-group analyses to explore heterogeneity and GRADE approach to assess the certainty of the evidence. Seventy-one eligible articles (239,467 screened) at low to moderate risk of bias included 235,752 participants. Higher SBP was associated with reduced all-cause mortality (HR 0.93, 95%CI 0.91–0.95, I2 = 87.13%, moderate certainty), all-cause hospitalization events (HR 0.91, 95%CI 0.88–0.93, I2 = 44.4%, high certainty) and their composite endpoint (HR 0.93 per 10 mmHg, 95%CI 0.91–0.94, I2 = 86.3%, high certainty). DBP did not demonstrate a statistically significant effect for all outcomes. The association strength was significantly weaker in studies following patients with either LVEF > 40%, higher average SBP (> 130 mmHg), increasing age and diabetes. All other a priori subgroup hypotheses did not explain between study differences. Higher ambulatory SBP is associated with reduced risk of all-cause mortality and hospitalization. Patients with lower BP and reduced LVEF are in a high-risk group of developing adverse events with moderate certainty of evidence.

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Acknowledgements

The authors thank Derrick Chang for his invaluable help performing citation screening.

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Authors and Affiliations

  1. Faculty of Medicine, University of Toronto, Toronto, ON, Canada

    Michael H. Lee, Abdullah Malik, Alanna Rigobon & Kathleen O’Brien

  2. Ted Rogers Centre for Heart Research, University Health Network, Toronto, ON, Canada

    Michael H. Lee, Mariela Leda, Tayler Buchan, Abdullah Malik, Alanna Rigobon, Farid Foroutan, Heather Ross & Ana Carolina Alba

  3. McMaster University, Hamilton, ON, Canada

    Mariela Leda, Reed Siemeiniuk, Nigar Sekercioglu & Farid Foroutan

  4. University of Toronto, Toronto, ON, Canada

    Helen Liu, Julian F. Daza, Heather Ross & Ana Carolina Alba

  5. Columbia University, New York City, NY, USA

    Madeleine Stein

  6. Faculty of Medicine, Ottawa University, Ottawa, ON, Canada

    Nicholas Ng Fat Hing

  7. Section of Orthopedic Surgery, University of Calgary, Calgary, AB, Canada

    Nathan Evaniew

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  1. Michael H. Lee
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  2. Mariela Leda
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Contributions

Conception and design: FF, HR, ACA. Drafting the article: MHL, ML. Revising the article: all authors. Provided intellectually content of critical importance to the work described: all authors. Final approval of the version to be published: all authors.

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Correspondence to Ana Carolina Alba.

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Lee, M.H., Leda, M., Buchan, T. et al. Prognostic value of blood pressure in ambulatory heart failure: a meta-analysis and systematic review. Ambulatory blood pressure predicts heart failure prognosis. Heart Fail Rev 27, 455–464 (2022). https://doi.org/10.1007/s10741-021-10086-w

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