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Open Access Research article

The prognostic importance of a history of hypertension in patients with symptomatic heart failure is substantially worsened by a short mitral inflow deceleration time

Charlotte Andersson13*, Gunnar H Gislason1, Peter Weeke1, Jesper Kjaergaard2, Christian Hassager2, Dilek Akkan2, Jacob E Møller2, Lars Køber2, Christian Torp-Pedersen1 and EchoCardiography and Heart Outcome Study (ECHOS) investigators

  • * Corresponding author: Charlotte Andersson ca@heart.dk

Author Affiliations

1 Department of Cardiology, Gentofte Hospital, Hellerup, Denmark

2 The Heart Centre, Rigshospitalet, Copenhagen, Denmark

3 Department of Cardiology, Copenhagen University Hospital, Gentofte Niels Andersens Vej 65, DK 2900, Hellerup, Denmark

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BMC Cardiovascular Disorders 2012, 12:30  doi:10.1186/1471-2261-12-30

Published: 25 April 2012

Abstract

Background

Hypertension is a common comorbidity in patients with heart failure and may contribute to development and course of disease, but the importance of a history of hypertension in patients with prevalent heart failure remains uncertain.

Methods

3078 consecutively hospitalized heart failure patients (NYHA classes II-IV) were screened for the EchoCardiography and Heart Outcome Study (ECHOS). The left ventricular ejection fraction (LVEF) was estimated by 2 dimensional transthoracic echocardiography in all patients and a subgroup of 878 patients had additional data on pulsed wave Doppler assessment of transmitral flow available. A restrictive filling (RF) was defined as a mitral inflow deceleration time ≤140 ms. Patients were followed for a median of 6.8 (Inter Quartile Range 6.6-7.0) years and multivariable Cox regression models were used to assess the risk of all-cause mortality associated with hypertension.

Results

The study population had a mean age of 73 ± 11 years. 39% were female, 27% had a history of hypertension and 48% had a RF. Over the study period, 64% of the population died. Hypertension was not associated with increased risk of mortality, hazard ratio (HR) 0.95 (0.85-1.05). LVEF did not modify this relationship (p for interaction = 0.7), but RF pattern substantially influenced the outcomes associated with hypertension (p for interaction < 0.001); HR 0.75 (0.57-0.99) and 1.41 (1.08-1.84) in patients without and with RF, respectively.

Conclusions

In patients with symptomatic heart failure, a history of hypertension is associated with a substantially increased relative risk of mortality among patients with a restrictive transmitral filling pattern.