Prognostic Significance of Diastolic Hypotensive Episodes in Patients Stabilized After Acute Heart Failure.

Abstract

Background: Optimal blood pressure (BP) management is important for improving clinical outcome for patient with heart failure. While systolic BP has traditionally guided therapy, the prognostic value of transient diastolic hypotension in chronic heart failure is unclear. This study aimed to evaluate whether a single episode of diastolic BP (DBP) <60 mmHg predicts adverse cardiovascular events in heart failure patients who achieved clinical stability after acute decompensation.

Methods: In this multicenter retrospective cohort study, data were extracted from the electronic health records of three tertiary university hospitals in South Korea (January 2017-June 2024). A total of 2,477 patients hospitalized for acute heart failure decompensation and stabilized thereafter were included, with BP measurements obtained 3-12 times during a 1-year follow-up. Major adverse cardiovascular events (MACE) defined as cardiovascular death, new myocardial infarction, stroke, or heart failure re-hospitalization was tracked from 1 year after discharge.

Results: Patients experiencing ≥1 DBP <60 mmHg episode had higher MACE rates (35.0% vs. 26.9%, p<0.01) and increased heart failure re-hospitalization (24.4% vs. 15.2%, p<0.01). In multivariable analyses, a DBP <60 mmHg episode was borderline associated with MACE (HR 1.18, p=0.07) and independently predicted heart failure re-hospitalization (HR 1.39, p<0.01).

Conclusions: A diastolic hypotension episode (DBP <60 mmHg) in patients with stable heart failure is a clinically significant marker of hemodynamic vulnerability and an elevated risk of adverse outcomes, particularly HF re-hospitalization. Monitoring SBP and diastolic parameters is important for optimizing HF management strategies.