Early drop in systolic blood pressure is associated with poor diuretic response and prognosis in patients with acute heart failure

Eur Heart J Acute Cardiovasc Care. 2022 Nov 2;11(10):749-757. doi: 10.1093/ehjacc/zuac105.


Aims: Although an excessive drop in systolic blood pressure (SBP) during acute heart failure (AHF) negatively impacts prognosis, the association between changes in SBP and the diuretic response (DR) is unclear. We aimed to clarify the association between an early drop in SBP and DR/prognosis in patients with AHF.

Methods and results: This was a sub-analysis of the REALITY-AHF study, which registered patients with AHF admitted through emergency departments (EDs). An early SBP drop was defined as the difference between baseline SBP and the lowest value during the first 48 h of hospitalization. DR was defined as the urine output achieved per 40 mg of intravenous furosemide administered. SBP was measured on admission, at 90 min, and 6, 24, and 48 h after admission. Patients were divided into four groups according to their median SBP drop and DR: greater SBP drop/poor DR (n = 322), smaller SBP drop/poor DR (n = 409), greater SBP drop/good DR (n = 419), and smaller SBP drop/good DR (n = 314). The study included 1,464 patients. A greater SBP drop/poor DR was associated with higher baseline SBP and vasodilator use. Multivariable linear regression analysis showed that a greater drop in SBP was associated with poorer DR following adjustment for potential covariates. Cox proportional hazards analysis demonstrated that a greater SBP drop/poor DR was independently associated with 1-year mortality. Both SBP and DR changes were independently associated with prognosis.

Conclusion: An early drop in SBP during the first 48 h of hospitalization was associated with poor DR and 1-year mortality in patients with AHF.

Clinical trial registration: URL: http://www.umin.ac.jp/ctr/Unique identifier: UMIN000014105.

Keywords: Acute heart failure; Diuretic response; Early drop in systolic blood pressure; Prognosis.

MeSH terms

  • Acute Disease
  • Blood Pressure / physiology
  • Diuretics* / therapeutic use
  • Furosemide / therapeutic use
  • Heart Failure* / complications
  • Heart Failure* / drug therapy
  • Humans
  • Prognosis


  • Diuretics
  • Furosemide