PS 14-20 THE RELATIONSHIP BETWEEN BLOOD PRESSURE AT DISCHARGE AND THE LONG-TERM CLINICAL OUTCOME IN PATIENTS WHO UNDERWENT CARDIAC REHABILITATION. (September 2016) - Fujishima, Shinichiro
Abstract : Objective: There is concern that excessive blood pressure (BP) lowering may result in worsening of prognosis in patients with cardiovascular diseases. We examined the relationship between BP levels at discharge and prognosis in patients who underwent cardiac rehabilitation. Design and Method: One hundred and fifty-four consecutive cases (133 patients; 69 males, 79 ± 12 years, mean ± SD) who discharged after cardiac rehabilitation were studied. The initial causes of admission were worsening of heart failure (HF, n = 101), acute myocardial infarction (n = 38), rehabilitation post cardiovascular surgery (n = 9), and acute aortic dissection (n = 4). The occurrence of composite events (rehospitalization for cardiovascular events or all-cause death) up to 2 years was investigated. The mean follow-up period was 440 days (2–731 days). Results: A total of 72 composite events occurred (rehospitalization, n = 58; all-cause death, n = 14). The event rate was lowest in the fourth systolic BP (SBP) quintile (Q4, SBP 115–125 mmHg). Hence, we recategorized the Q1-Q3, the Q4, and the Q5 into the low (L, n = 94), the middle (M, n = 28), and the high (H, n = 32) SBP group in the subsequent analyses. The event rates in the L, M, and H group were 54%, 25%, and 44%, respectively (p = 0.02). A multivariate Cox proportional hazards model, including significant factors in univariate analyses, demonstrated that age (hazard ratio (HR) /1year, 1.057; 95% CI, 1.002–1.095; p = 0.002) and blood pressure (HR of the middle BP group, 0.353; 95%CI, 0.156–0.795; p = 0.012) were independent predictors of the composite events. Conclusions: There was a J-shaped curve relationship between the systolic BP at discharge and the long-term prognosis in patients who underwent cardiac rehabilitation: the event rate was lowest in the group with systolic BP of 115–125 mmHg.