The Relationship Between The Level Of Diastolic Blood Pressure On Admission And The Prognosis Of Patients With Heart Failure

Background and objective:Heart failure(HF)is the final stage of various heart diseases,with high morbidity,high mortality and high medical costs,which seriously threatens human health,reduces the quality of life of patients,and adds a huge economic burden to individuals and society.Although the progress in the treatment of heart failure has improved the prognosis of patients with heart failure,it is still a major public health problem facing the world.Early risk assessment of patients with heart failure,so as to achieve early identification,early prevention and early treatment,is particularly important to improve the prognosis of patients with heart failure.Blood pressure,which is simple,convenient and cheap to measure,has attracted more and more attention as an index to predict the prognosis of patients with heart failure.The blood pressure at admission is not only one of the vital signs to judge the severity of hospitalized patients,but also an important index to reflect the changes of systemic hemodynamics in patients with heart failure.Therefore,it is of great clinical significance to use the blood pressure at admission to predict the prognosis of patients with heart failure.However,the correlation between diastolic blood pressure(DBP)on admission and the prognosis of patients with heart failure is still controversial.However,it is found that the level of DBP on admission has important clinical value for evaluating the prognosis of patients with heart failure in the actual clinical work.Therefore,a retrospective cohort study was conducted to explore the relationship between the level of DBP on admission and the prognosis of patients with heart failure.Methods:This study selected 962 patients with heart failure who were hospitalized in the Department of Cardiology of Shandong Province Qian Foshan Hospital from January 2016 to June 2018,including 514 males and 448 females,with an average age of 72.23±11.42 years.The general clinical data of the selected patients were collected,including DBP at admission,heart rate(HR)at admission,sex,age,New York heart association(NYHA)classification grading of cardiac function,complications,B-type natriuretic peptide(BNP),albumin,low density lipoprotein,left ventricular ejection fraction(LVEF),hospitalization days,etc.The patients were followed up,with the date of admission as the starting follow-up time,and the end event was defined as all-cause death.The deadline for follow-up was June 2019.During the follow-up period,if the patient had an end event,the follow-up would be terminated.The occurrence of terminal events during the follow-up period was recorded and the survival time was calculated.According to the level of DBP at admission,the patients with heart failure were divided into three groups:low DBP group(DBP<60mmHg),normal DBP group(60?DBP<80mmHg)and high DBP group(DBP?80mmHg).First of all,the general clinical data of patients with heart failure were compared among different DBP groups at admission.Secondly,the patients with heart failure were divided into different DBP groups at admission,and the indexes with significant differences in general clinical data among different groups were analyzed by correlation analysis with DBP at admission.Finally,Kaplan-Meier univariate survival analysis(Log-rank test)and Cox proportional hazard regression model were used to study the relationship between different levels of DBP at admission and the prognosis of patients with heart failure.Results:1.Compared with low DBP group,normal DBP group and high DBP group,there were significant differences in age,proportion of hypertension,proportion of cardiac arrhythmia(complication),proportion of rheumatic heart disease,proportion of grade NYHA ?,DBP at admission,HR at admission,BNP,hemoglobin,total cholesterol,serum uric acid,low density lipoprotein,serum sodium,homocysteine,and hospitalization days(P<0.05)2.DBP at admission was correlated with age,hypertension,cardiac arrhythmia(complication),rheumatic heart disease,HR at admission,BNP,hemoglobin,serum sodium,total cholesterol and low density lipoprotein(P<0.05).DBP at admission was positively correlated with hypertension,cardiac arrhythmia(complication),HR at admission,serum sodium,total cholesterol,hemoglobin and low density lipoprotein(P<0.05),and was negatively correlated with age,rheumatic heart disease and BNP(P<0.05).3.Survival analysis of patients with heart failure:The results of univariate survival analysis showed that there were significant differences in DBP at admission,NYHA cardiac function grade,hypertension,BNP,serum potassium,sodium,age,HR at admission,hemoglobin,glucose,albumin,total cholesterol,prealbumin,serum uric acid,LVEF and hospitalization days in patients with heart failure(P<0.05)Multivariate survival analysis showed that low DBP at admission,normal DBP at admission,NYHA II grade,hypertension,normal serum potassium level,age,HR at admission,albumin,serum uric acid and glucose were the prognostic factors of patients with heart failure(P<0.05).Conclusion:Low DBP and normal DBP at admission are risk factors for the prognosis of patients with heart failure.Patients with low DBP and normal DBP at admission have a higher risk of all-cause death.Different levels of DBP at admission are helpful to evaluate the prognosis of patients with heart failure.