SUMMARYThe aim of the present prospective, single centre observational study was to describe the profile and prognosis of patients hospitalised with chronic heart failure and to determine the value of discharge blood pressure and cholesterol for long-term survival.From among 2,346 hospitalised patients, 320 (13.6%) suffered from chronic heart failure and 28 (8.8%) died during hospitalisation. The in-patient mortality rate was similar to that in patients not suffering from chronic heart failure (P = 0, 3). Of 292 patients who were discharged, 162 (55%) died during the subsequent 5 years. The predetermined parameters of pure prognosis were associated with lower diastolic blood pressure (P = 0.008) and lower cholesterol (P = 0.012). A poor prognosis was associated with lower systolic blood pressure plus lower cholesterol and lower diastolic blood pressure and lower cholesterol. Other independent prognostic parameters were older age (P < 0.001), higher heart rate (P = 0.02), higher creatinine (P < 0.001), higher urea (P < 0.001), higher uric acid (P < 0.001), lower hemoglobin (P = 0.02), lower ejection fraction (P = 0.080), and a history of ischemic heart disease (P < 0.01).Patients suffering from chronic heart failure and discharged home have a worse prognosis if their systolic and/or diastolic blood pressures and/or cholesterol levels are too low. The optimal values seem to be levels that are around the recommended targets, that is a systolic BP of 140 mmHg, diastolic BP of 90 mmHg, and a cholesterol level of 5 mmol/L. (Int Heart J 2008; 49: 691-705) Key words: Heart failure, Prognosis, Blood pressure, Cholesterol HEART failure is a major cause of serious morbidity and death in the overall population and one of the leading medical causes of hospitalisation amongst people over 60 years old.1-5) Chronic heart failure is an epidemic of the 21st centuryFrom the
In this double-blind, placebo-controlled, randomised, parallel-group study, a combination tablet of candesartan cilexetil/hydrochlorothiazide (HCTZ), 16/12.5 mg once daily, reduced sitting diastolic blood pressure (DBP) significantly more (p = 0.037) than candesartan cilexetil/placebo, 16 mg once daily, in patients with mild to moderate primary hypertension (n = 328) who had not reached target blood pressure with candesartan cilexetil, 16 mg once daily. At the end of the 8-week double-blind treatment period, the adjusted mean reductions in sitting DBP, 24 h post dose, were 7.5 mm Hg in the candesartan cilexetil/HCTZ treatment group and 5.5 mm Hg in the candesartan cilexetil/placebo treatment group, corresponding to an adjusted mean difference between treatments of 2.0 mm Hg in favour of candesartan cilexetil/HCTZ (95% CI 0.1-3.8 mm Hg, p = 0.037). The adjusted mean reductions in sitting systolic blood pressure, 24 h post dose, were 12.0 mm Hg and 7.5 mm Hg, respectively, corresponding to an adjusted mean difference between treatments of 4.5 mm Hg (95% CI 1.1-8.0, p = 0.01). Consistent with the placebo-like tolerability of candesartan cilexetil reported in other studies, both treatments were very well tolerated, with a similar pattern and low frequency of adverse events in both treatment groups.
Background: Chronic heart failure is characterized by high mortality, frequent hospitalization, and reduced quality of life. Patients with severe heart failure are often in very poor physical condition, they are unable to take part in the usual exercise programs, and therefore need an individual approach. Hypothesis: To assess the systemic and pulmonary hemodynamic responses to maximum voluntary contraction of the lower extremity muscles (MVC-LEM) with persistent physiologic breathing, the Valsalva maneuver, and the combination of Valsalva with MVC-LEM. Methods: Seventeen patients with severe heart failure (ejection fraction 20%) were exposed to 3 types of load for a period of 10 seconds: 1) MVC-LEM with persistent physiologic breathing, 2) the Valsalva maneuver, and 3) a combination of MVC-LEM with the Valsalva maneuver. During each measurement, a continuous, timesynchronized record was taken of the electrocardiogram, and the pulmonary and systemic blood pressures. Results: There were slight changes in the heart rate and systemic blood pressure when comparing resting versus MVC-LEM values. There were much greater and significant changes (P < .01) in the systemic and pulmonary blood pressures when comparing resting versus the Valsalva maneuver or the combination of the MVC-LEM plus the Valsalva maneuver values. Conclusions: A short maximum voluntary contraction of the muscles of the lower extremities with persistent physiologic breathing did not have an abnormal effect on the systemic and pulmonary hemodynamics in patients with severe chronic heart failure. The Valsalva maneuver caused significantly higher hemodynamic changes in the systemic and pulmonary system with possible negative effects.
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