Date of Award

January 2015

Document Type

Open Access Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Jeffrey M. Testani

Subject Area(s)

Medicine

Abstract

Background: Reductions in blood pressure are common during the treatment of acute decompensated heart failure (ADHF) and strongly associated with worsening renal function (WRF). However, it is unclear whether a decline in systolic blood pressure (SBP), and the associated deterioration in renal function, might limit successful diuresis.

Methods: We analyzed consecutive admissions with a primary discharge diagnosis of ADHF (n=657). Metrics of diuresis were assessed for their association with a decline in SBP from admission to discharge in addition to the use or titration of guideline recommended heart failure therapies (GDMT). SBP-reduction was defined as a relative reduction in SBP greater than the median value (>9.9%).

Results: Overall 77.6% of the population had a discharge SBP lower than the admission value. SBP-reduction resulted in significantly higher rates of WRF (OR= 1.9, p=0.004). Despite the negative impact on renal function, SBP-reduction was not associated with worse diuretic efficiency (p=0.274). Furthermore, the rate of hemoconcentration, net fluid loss, weight loss, adjuvant thiazide diuretic use, and loop diuretic infusion use was not different for patients with an SBP-reduction (p≤0.293for all). GDMT such as ACE-Is and beta blockers were associated with SBP-reduction but not with metrics of decongestion.

Conclusion: Despite apparent negative effects on renal function, a reduction in blood pressure or titration of GDMT did not appear to limit successful decongestion.

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