When High Blood Pressure Means Lower Death Risk, but More Hospitalization

A study being presented this week at the American College of Cardiology (ACC) 66^th Scientific Session finds that for some patients, having high systolic blood pressure does not lead to a higher risk of death, even though there are important implications for managed care.

The study, involving the Gulf-CARE registry and funded by Servier, a French pharmaceutical company, examined health records of 2492 patients with type 2 diabetes (T2D) who were among 5005 hospitalized with acute heart failure in 7 Middle Eastern countries: Oman, Saudia Arabia, Yemen, Kuwait, Qatar, Bahrain, and United Arab Emirates.

Results show that patients with both T2D and acute heart failure had a lower risk of death—but a higher risk of heart-related hospitalization—if they had high systolic blood pressure when discharged from the hospital, when compared with those with normal blood pressure. Although this study does not involve US health records, it’s worth looking at the results given that Medicare and many commercial health plans in the United States closely scrutinize 30-day readmission rates, and hospitals can face penalties for failing to meet targets in this area.

A statement from the ACC said this was the first study to examine blood pressure and health outcomes among people with T2D and among those with heart failure. Those with systolic blood pressure above 150 mmHg were 45% less likely to die, but 47% more likely to be hospitalized for heart failure during a 12-month follow up period. A normal systolic blood pressure reading should be lower than 140 mmHg in patients with diabetes, and lower than 130 mmHg in everyone else.

However, patients suffering from both conditions may have a “distinct pathophysiology of the heart and may benefit from different guidelines,” said lead study author Charbel Abi Khalil, MD, PhD, assistant professor of medicine and genetic medicine at Weill Cornell Medicine and cardiology consultant at the heart hospital Hamad Medical Corporation in Doha, Qatar.

Abi Khalil speculated that the results may point to a “blood pressure paradox,” which could be similar to a phenomenon known as the “obesity paradox,” in which patients with obesity and T2D have better survival that those without. Because this is an association and not a cause and effect, it’s been speculated that this may occur because these patients are followed more closely by physicians, and the same may be true of patients with heart failure and diabetes. The frequent follow-ups may suggest more care by cardiologists and diabetes specialists, along with early diagnosis of other health problems.