Pulse

When high blood pressure can be a good thing

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A single number may foretell life expectancy during recovery from heart failure.

A new study points to systolic blood pressure — the top number in a blood pressure measurement — as a key to predicting mortality and life expectancy following hospitalization for acute decompensated heart failure (ADHF).

Millions take medication to help lower their blood pressure. But for those hospitalized with ADHF, a higher systolic number — above 130 —is best, according to the research published in the European Journal of Internal Medicine. The research showed that a reading below 130 at discharge or within 30 days was linked to higher mortality and shorter life expectancy.

More than one million Americans are admitted to the hospital annually with a diagnosis of heart failure. Hospitalization for ADHF represents a critical turning point in the natural progression of chronic heart failure.

“All that we know about blood pressure is in patients who are seen in an outpatient setting and followed in outpatient,” explains Rehan Qayyum, MD, Harry H. Mansbach Chair in Internal Medicine and Chair of the Department of Medicine at Macon & Joan Brock Virginia Health Sciences at Old Dominion University. He was among 17 co-authors of the study that included experts from the Mayo Clinic and Harvard Medical School.

“We have been using the same numbers for those patients who are hospitalized although we have no data on what good blood pressure is in hospitalized patients,” Dr. Qayyum said. “This study is trying to provide some evidence to address this knowledge gap.”

The study shows that hospitalized patients may not benefit from tighter blood pressure control.

“There could be several potential reasons for this, including that the normal response of the body to stress is raising blood pressure,” he said. “Lowering blood pressure may interfere with this stress response.”

Another possibility, he said, is that patients who were unable to raise their blood pressure as a normal response were likely sicker. It is also possible that in heart failure patients, the heart has already weakened enough that it cannot raise blood pressure high enough. This poor cardiac function is then associated with higher mortality.

The research is based on an analysis of the medical records of 14,611 adults who survived ADHF hospitalization at 17 hospitals from 2010 to 2022, with follow up until May 2023.