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To the Editor: In their cohort study of outcomes in patients hospitalized with acute heart failure, Dr Gheorghiade and colleagues¹ showed that lower systolic blood pressure (SBP) at admission predicts worse outcomes in patients with both reduced and preserved systolic function. In their discussion, they suggested that SBP may indicate different stages or pathophysiology of heart failure, which accounts for higher mortality in patients with lower SBP.

However, the observed difference in mortality also can be explained in part by different etiologies of heart failure in each of the SBP quartiles. Whereas ischemic cardiomyopathy was more common in patients with lower SBP (50.7% for <120 mm Hg vs 39.2% for >161 mm Hg), nonischemic (ie, hypertensive) cardiomyopathy was more com-mon in those with higher SBP in the study sample (13.4% for <120 mm Hg vs 34.8% for >161 mm Hg). Because nonischemic cardiomyopathy has a more favorable prognosis than ischemic . . . [Full Text of this Article]

Dae Hyun Kim, MD, MPH
dae-hyun.kim@mail.tju.edu
Department of Medicine
Jefferson Medical College
Philadelphia, Pa

Hyunseok Kang, MD
Yonsei University Graduate School of Public Health
Seoul, Korea

RELATED LETTER

Systolic Blood Pressure and Outcomes in Patients Hospitalized With Acute Heart Failure—Reply
Mihai Gheorghiade and Gregg C. Fonarow
JAMA. 2007;297(8):808-809.
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Systolic Blood Pressure at Admission, Clinical Characteristics, and Outcomes in Patients Hospitalized With Acute Heart Failure
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JAMA. 2006;296(18):2217-2226.
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