The lowest tertile of peak exercise systolic blood pressure was independently associated with a significantly higher risk of all-cause mortality compared to the highest tertile (p=0.009).
Observational (n=239)
Do exercise blood pressure profiles during cardiopulmonary exercise testing predict mortality and rehospitalization in patients with heart failure?
Lower resting and peak systolic blood pressure during cardiopulmonary exercise testing identify a high-risk phenotype for mortality in heart failure patients, particularly those with reduced ejection fraction.
p-value: p=0.009
Objective: Blood pressure (BP) dynamics during exercise reflect integrated cardiovascular reserve and may provide prognostic information in heart failure (HF). However, the clinical relevance of exercise BP profiles across different HF phenotypes has not been fully investigated. Design and method: Consecutive patients with established HF undergoing cardiopulmonary exercise testing (CPET) were studied. Blood pressure variables were categorized into tertiles, with the highest tertile used as the reference group, to assess non-linear associations with outcomes and enhance clinical interpretability. DSBP was defined: SBPat peak-SBPat rest. Patients were classified as HF with preserved ejection fraction (HFpEF, LVEF >=50%) or reduced ejection fraction (HFrEF, LVEF <50%). All-cause mortality and HF rehospitalization were evaluated. Results: A total of 239 patients (57 ± 13.5 years, 72% male) were included. HFpEF patients exhibited higher resting systolic BP (p=0.001), peak exercise SBP (p<0.001), and DSBP (p<0.001), whereas HFrEF patients demonstrated lower peak VO2% (64.3 ± 22.5 vs 80.1 ± 21.5% predicted) and higher VE/VCO2 slope (34.4 ± 11.4 vs 31.8 ± 9.6). Mortality rates decreased across increasing DSBP tertiles (26.1%, 18.2%, and 8.9%). Lower tertiles of peak exercise SBP were strongly associated with increased mortality; compared with the highest tertile, patients in the lowest peak SBP tertile had a significantly higher risk of death in both unadjusted (p=0.001) and adjusted analyses (p=0.009). Lower resting SBP tertiles were also independently associated with mortality (p=0.034), whereas DSBP tertiles were not. No SBP tertile parameter independently predicted rehospitalization; rehospitalization risk was driven by HFrEF phenotype (p<=0.004) and ventilatory inefficiency (VE/VCO2 slope). Conclusions: Exercise BP profiles provide clinically relevant prognostic information in HF. Lower resting and peak systolic BP identify a high-risk phenotype, particularly among patients with reduced ejection fraction, beyond functional capacity and ventilatory efficiency. Exercise BP is a marker of survival rather than recurrent hospitalization.
Kariori et al. (Fri,) conducted a observational in Heart failure (n=239). Lowest tertile of peak exercise systolic blood pressure vs. Highest tertile of peak exercise systolic blood pressure was evaluated on All-cause mortality (p=0.009). The lowest tertile of peak exercise systolic blood pressure was independently associated with a significantly higher risk of all-cause mortality compared to the highest tertile (p=0.009).
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