Among individuals hospitalized for acute heart failure (HF), a larger early reduction in systolic blood pressure (BP) correlated with greater risk for 180-day cardiovascular (CV) death, as well as higher incidences of worsening HF and renal function, according to a study published in JACC: Heart Failure.

This posthoc analysis included 6544 individuals hospitalized for acute HF who took part in the Relaxin in Acute Heart Failure-2 (RELAX-AHF-2) trial ( Identifier: NCT01870778). All participants received either intravenous serelaxin 30 µg/kg/d or matching placebo for 48 hours. BP measurements took place regularly (intervals of ≤3 hours) throughout this period, with the difference between baseline systolic BP measurement and the lowest measured systolic BP in the first 48 hours constituting the peak systolic BP drop. The study researchers defined worsening renal function as a 0.3 mg/dL or greater increase in serum creatinine from day 0 to day 5. Multivariable linear regression was used to investigate determinants of peak systolic BP drop.

After adjustment for baseline systolic BP, peak systolic BP drop was associated with a greater risk for worsening renal function (hazard ratio [HR], 1.11 per 10 mm Hg drop in systolic BP; 95% CI, 1.07-1.16; P <.001), 180-day CV death (HR, 1.09 per 100 mm Hg drop in systolic BP; 95% CI, 1.01-1.18; P =.026), and 5-day worsening HF (HR, 1.12 per 10 mm Hg drop in systolic BP; 95% CI, 1.03-1.22; P =.006). The prognostic value of early systolic BP drop was not associated with worsening renal function.

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Limitations to this study include potential confounding by treatments administered after the early time period, as well as a potential lack of generalizability.

“We found that an early drop in [systolic] BP observed during the first 48 hours of a hospitalization for [acute] HF was associated with [worsening renal function], 5-day [worsening] HF, and 180-day CV mortality,” the study authors noted. “However, [worsening renal function] was not strongly related to worse outcomes, and the prognostic value of a drop in [systolic] BP on 5-day [worsening] HF and 180-day CV death was not modified by the occurrence of [worsening renal function].”

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.


Matsue Y, Sama IE, Postmus D, et al. Association of early blood pressure decrease and renal function with prognosis in acute heart failure. J Am Coll Cardiol HF. Published online October 6, 2021. doi:10.1016/j.jchf.2021.07.001

This article originally appeared on The Cardiology Advisor