Systemic BP and heart rate as prognostic indicators in pulmonary arterial hypertension

Background: Heart rate (HR) and systolic BP (SBP) are signifi cant multivariate predictors of survival in patients with pulmonary arterial hypertension (PAH) as part of a 19-element formula. To what extent HR and BP alone predict survival and future hospitalization in patients with PAH is unknown. Methods: We analyzed data from the Registry to Evaluate Early and Long-term PAH Disease Management (REVEAL Registry), a prospective, observational study of patients with PAH. Patients were analyzed by quintile (Q) according to values of HR, SBP, and SBP/HR. Kaplan-Meier curves were calculated by Q for survival and freedom from hospitalization. Results: For patients in the worst Q, 1-year survival after enrollment was 85% ± 2% for SBP, 86% ± 2% for HR, and 84% ± 2% for SBP/HR vs 91% ± 1% for the middle three Qs (P <.001). Hospitalization occurred more frequently than mortality but with a similar pattern among Qs. One-year survival after fi rst follow-up of patients in the worst Q for change (Δ) in SBP since enrollment was 85% ± 2% (P =.004), 86% ± 2% for Δ HR (P =.12), and 84% ± 2% for ± SBP/HR (P =.024) vs the middle three Qs (Δ SBP: 91% ± 1%; Δ HR: 90% ± 1%; Δ SBP/HR: 90% ± 1%). Conclusions: Changes in vital signs from enrollment to fi rst follow-up were less predictive of mortality than the values of vital-sign parameters at either enrollment or fi rst follow-up. HR, SBP, and SBP/HR at enrollment identifi ed high-risk groups with survival differences of 5% to 7% and freedom from hospitalization differences of 9% to 11% vs lower-risk groups. SBP/HR defi nes the highest-risk group, including most of the high-risk patients defi ned by HR and SBP separately.