Evidence map›Paper›PMID 31221253›Full record

ArticleJournal of the American College of Cardiology2019

Systolic Blood Pressure and Outcomes in Patients With Heart Failure With Reduced Ejection Fraction.

Cherinne Arundel, Phillip H Lam, Gauravpal S Gill, Samir Patel, Gurusher Panjrath, Charles Faselis, Michel White, Charity J Morgan, Richard M Allman, Wilbert S Aronow and 3 more

Open access · bronzeAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Journal of the American College of Cardiology, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 37 papers.

0numbers the graph read from it
0cells of the map it votes in
37citing papers in PubMed
5.5field-weighted citation impact, top 3% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

37 citing papers in PubMed, 72 citations in OpenAlex.

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  3. Beyond "lower is better" in antithrombotic strategy for coronary artery disease and atrial fibrillation.Hypertension research : official journal of the Japanese Society of Hypertension · 2026
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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

13 authors at 8 institutions in 2 countries.

Cherinne ArundelMedical Service, Veterans Affairs Medical Center, Washington, DC; Department of Medicine, George Washington University, Washington, DC; Department of Medicine, Georgetown University, Washington, DC.
Phillip H LamDepartment of Medicine, Georgetown University, Washington, DC; Department of Medicine, MedStar Washington Hospital Center, Washington, DC; Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
Gauravpal S GillMedical Service, Veterans Affairs Medical Center, Washington, DC; Department of Medicine, MedStar Washington Hospital Center, Washington, DC.
Samir PatelMedical Service, Veterans Affairs Medical Center, Washington, DC.
Gurusher PanjrathDepartment of Medicine, George Washington University, Washington, DC.
Charles FaselisMedical Service, Veterans Affairs Medical Center, Washington, DC; Department of Medicine, George Washington University, Washington, DC.
Michel WhiteDepartment of Medicine, University of Montreal and Montreal Heart Institute, Montreal, Quebec, Canada.
Charity J MorganMedical Service, Veterans Affairs Medical Center, Washington, DC; Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama.
Richard M AllmanDepartment of Medicine, George Washington University, Washington, DC.
Wilbert S AronowDepartment of Medicine, New York Medical College and Westchester Medical Center, Valhalla, New York.
Steven N SinghMedical Service, Veterans Affairs Medical Center, Washington, DC; Department of Medicine, Georgetown University, Washington, DC.
Gregg C FonarowDepartment of Medicine, University of California, Los Angeles, California.
Ali AhmedMedical Service, Veterans Affairs Medical Center, Washington, DC; Department of Medicine, George Washington University, Washington, DC; Department of Medicine, Georgetown University, Washington, DC. Electronic address: ali.ahmed@va.gov.
Georgetown University · USGeorge Washington University · USVeterans Health Administration · USBrigham and Women's Hospital · USMedStar Washington Hospital Center · USMontreal Heart Institute · CAUniversity of California, Los Angeles · USWestchester Medical Center · US

Funding

Heart failure, chronic kidney disease, and renin-angiotensin system inhibitionR01HL085561 · NHLBI · UNIVERSITY OF ALABAMA AT BIRMINGHAM · PI AHMED, ALI · 2006 to 2009
$1.5M
Neurohormonal Blockade and Outcomes in Diastolic Heart FailureR01HL097047 · NHLBI · UNIVERSITY OF ALABAMA AT BIRMINGHAM · PI AHMED, ALI · 2009 to 2010
$915k
NHLBI NIH HHS R01 HL085561NHLBI NIH HHS R01 HL097047
6 · The paper itself

Abstract

backgroundNational guidelines recommend that systolic blood pressure (SBP) in patients with heart failure with reduced ejection fraction (HFrEF) and hypertension be maintained below 130 mm Hg.

objectivesThis study sought to determine associations of SBP <130 mm Hg with outcomes in patients with HFrEF.

methodsOf the 25,345 patients in the Medicare-linked OPTIMIZE-HF registry, 10,535 had an ejection fraction (EF) ≤40%. Of these, 5,615 had stable SBP (≤20 mm Hg admission to discharge variation), and 3,805 (68%) had a discharge SBP <130 mm Hg. Propensity scores for SBP <130 mm Hg, estimated for each of the 5,615 patients, were used to assemble a matched cohort of 1,189 pairs of patients with SBP <130 versus ≥130 mm Hg, balanced on 58 baseline characteristics (mean age 76 years; mean EF 28%, 45% women, 13% African American). This process was repeated in 3,946 patients, after excluding 1,669 patients (30% of 5,615) with a discharge SBP <110 mm Hg and assembled a second matched balanced cohort of 1,099 pairs of patients with SBP 110 to 129 mm Hg versus ≥130 mm Hg.

resultsThirty-day all-cause mortality occurred in 7% and 4% of matched patients with SBP <130 mm Hg versus ≥130 mm Hg, respectively (hazard ratio [HR]: 1.76; 95% confidence interval [CI]: 1.24 to 2.48; p = 0.001). HRs (95% CIs) for all-cause mortality, all-cause readmission, and HF readmission at 1 year, associated with SBP <130 mm Hg, were 1.32 (1.15 to 1.53; p < 0.001), 1.11 (1.01 to 1.23; p = 0.030), and 1.24 (1.09 to 1.42; p = 0.001), respectively. HRs (95% CIs) for 30-day and 1-year all-cause mortality associated with SBP 110 to 129 mm Hg (vs. ≥130 mm Hg) were 1.50 (1.03 to 2.19; p = 0.035), and 1.19 (1.02 to 1.39; p = 0.029), respectively.

conclusionsAmong hospitalized older patients with HFrEF, SBP <130 mm Hg is associated with poor outcomes. This association persisted when the analyses were repeated after excluding patients with SBP <110 mm Hg. There is an urgent need for randomized controlled trials to evaluate optimal SBP reduction goals in patients with HFrEF.

Indexed as

Blood PressureHeart FailureStroke VolumeVentricular Dysfunction, LeftAgedBlood Pressure DeterminationFemaleHospitalizationHumansMaleMedicareMortalityRegistriesRisk FactorsUnited Statesheart failureoutcomessystolic blood pressure

Identifiers

PMID31221253
PMCPMC10656059
OpenAlexW2949566731

What OpenQuestion holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.