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| |  Worsening Renal Function Associated With a Decrease in Systolic Blood Pressure in Acute Heart Failure: Presented at HFSA By Cheryl Lathrop BOSTON -- September 16, 2009 -- Worsening renal function (WRF) is associated with a decrease in systolic blood pressure (SBP) in patients with acute heart failure (ACF), according to a study presented here at the 13th Annual Scientific Meeting of the Heart Failure Society of America (HFSA). G. Michael Felker, Division of Cardiology, Duke Clinical Research Institute, Durham, North Carolina, reported on the relationship between WRF and decreased SBP during hospitalisation, during a poster session on September 14. The association between admission SBP, change in SBP, and the risk of WRF has not been studied. Hypertension and a higher SBP during hospital admission are associated with a higher risk of WRF. WRF during hospitalisation for ACF is related to a poorer prognosis. The study looked at these relationships. The Relaxin for the Treatment of Patients With Acute Heart Failure (Pre-RELAX-AHF) trial was an international, randomised, double-blind, placebo-controlled, parallel-group study comparing relaxin with placebo. Pre-RELAX-AHF inclusion criteria were: hospitalisation for acute heart failure, dyspnoea at rest or with minimal exertion, congestion on chest x-ray, and brain natriuretic peptide (BNP) >=350 or N-terminal (NT)-pro-BNP >=1,400 pg/mL, baseline systolic BP >=125 mm Hg, and renal dysfunction (epidermal growth factor receptor 30-75 mL/min). Patients were randomised within 16 hours of admission for AHF to placebo or 4 doses of relaxin (10, 30, 100, 250 mcg/kg/d) for 48 hours. The study analysed the relationship between the development of persistent WRF and the following potential predictors: baseline BP, change in BP, lowest absolute BP. Change in SBP was calculated as the difference between baseline and the lowest value measured during the first 48 hours of the study. Persistent worsening renal function was defined as an increase in serum creatinine of 0.3 mg/dL or more from baseline at both days 5 and 14. Persistent WRF in hospitalised AHF patients was strongly related to a relative drop in SBP during hospitalisation; it was not related to absolute lowest BP. Higher doses of relaxin (100, 250) more frequently caused SBP drop (compared with placebo) and more frequently caused WRF (10.8%, 15.2%, P = NS). Placebo and lower doses of relaxin (10, 30) that did not significantly influence BP were not related to WRF (6.8%, 7.5%, 7.3%, respectively). A higher baseline SBP (P < .001) and a greater drop in SBP during the first 48 hours of admission (P = .008) were the strongest predictors of persistent WRF. Persistent WRF was associated with a 5 times higher 60-day mortality (P < .001) and a ~3 times higher 180-day mortality (P = .009). [Presentation title: Worsening Renal Function in Acute Heart Failure: Change in Blood Pressure and Effects of Relaxin. Abstract 207]
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