In Reply: Drs Kim and Kang raise alternate explanations for our findings of the relationship between admission SBP and outcomes in patients hospitalized with acute heart failure. As they note, the etiologies for heart failure and LVEF did differ across SBP quartiles, with a greater proportion of patients in the lower SBP quartiles having an ischemic etiology and systolic dysfunction. While an ischemic etiology for heart failure has been associated with worse long-term survival in chronic heart failure, prior studies have not shown it to be an important predictor of short-term risk in hospitalized patients.1 In response to Kim and Kang, we stratified in-hospital mortality rates for the SBP quartiles by etiology (Table). Lower SBP quartiles were associated with higher mortality in patients with either ischemic or nonischemic etiology for heart failure. Furthermore, lower SBP as a continuous variable was predictive of higher in-hospital and postdischarge mortality in the first 60 to 90 days, independent of heart failure etiology.
Gheorghiade M, Fonarow GC. Systolic Blood Pressure and Outcomes in Patients Hospitalized With Acute Heart Failure—Reply. JAMA. 2007;297(8):807–809. doi:10.1001/jama.297.8.808
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