Date of Award
Open Access Thesis
Medical Doctor (MD)
Jeffrey M. Testani
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.
Kula, Alexander, "Blood-Pressure Reduction Is Associated With Worsening In Renal Function But Does Not Prevent Successful Decongestion In Patients Treated For Acute Decompensated Heart Failure" (2015). Yale Medicine Thesis Digital Library. 1987.
This Article is Open Access