Hypertensive Acute Decompensated Heart Failure Presentations: On the Decline? : A Master's Thesis

The signature of the Dean of the Graduate School of Biomedical Sciences signifies that the student has met all master's degree graduation requirements of the school. Dedication I would like to dedicate this thesis to my wife Mollie and my children Gavin and Iain. Without the support of my family as I pursue my academic career this thesis would not have been possible. Acknowledgements I would also like to acknowledge the members of my Thesis Advisory Committee (Dr. Medicine who has supported my research career over the last several years. Background: The initial systolic blood pressure (SBP) in patients with acute heart failure (AHF) can be used as a guide when choosing specific pharmacologic treatments by helping identify the underlying type of HF (e.g., HF with preserved ejection fraction). Clinical experience and research data from our medical center suggests that AHF with elevated SBP may be presenting less frequently than in the past. This may call into question the utility of initial SBP as a clinical guide. The goal of this Master's Thesis is to test the hypothesis that the frequency of AHF patients with a SBP>160mmhg has declined over time. Methods: This observational study compares data from 4 cohorts of adult patients admitted with AHF in central MA. Data were obtained from a contemporary (2011-2013) study of patients with AHF as well as from the 1995, 2000, 2006 Worcester Heart Failure Study (WHFS) cohorts. The Framingham criteria the diagnostic criterion for AHF. The main outcome was the proportion of patients with AHF with a SBP > 160 mmHg who presented in each of the 4 study cohorts and was examined by multivariate logistic regression. Results: 2,366 patients comprised the study population. The average age was 77 years, 55% were female, 94% white, and 75% had prior HF. In 1995 33.6% of AHF patients had a SBP >160 mmHg compared to 19.5% in 2011-2013 (p<0.01). Multivariate logistic regression demonstrated a reduced odds of patients presenting with Conclusion: The proportion of patients with AHF and an initial SBP >160 mmHg has significantly declined over time. This may warrant a reexamination of the utility of SBP to inform diagnosis and treatment in patients with AHF. Table 3.2 Demographic and clinical characteristics of patients with SBP> 160 mmHg over time Table 3.3 Odds ratios of SBP>160 mmHg at presentation over time PREFACE Data from the NHLBI funded training grant (K23HL101991, C. Darling PI) …