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Original Research: Pulmonary Vascular Disease |

Systemic BP and Heart Rate as Prognostic Indicators in Pulmonary Arterial HypertensionPrognosis in Pulmonary Hypertension by Vital Signs

Malcolm M. Bersohn, MD, PhD; Michelle P. Turner, MS; Glenna L. Traiger, RN, MSN; Adaani E. Frost, MD, FCCP; Shelley Shapiro, MD, PhD
Author and Funding Information

From the VA Greater Los Angeles Healthcare System and David Geffen School of Medicine (Drs Bersohn and Shapiro) at the University of California, Los Angeles, Los Angeles, CA; ICON Late Phase & Outcomes Research (Ms Turner), San Francisco, CA; University of California, Los Angeles (Ms Traiger), Los Angeles, CA; and Baylor College of Medicine (Dr Frost), Houston, TX.

Correspondence to: Malcolm M. Bersohn, MD, PhD, VA Greater Los Angeles Healthcare System, Cardiology (111E), 11301 Wilshire Blvd, Los Angeles, CA 90073; e-mail: mbersohn@ucla.edu


Funding/Support: Funding and support for the REVEAL Registry were provided by Cotherix Inc, and its affiliate Actelion Pharmaceuticals US Inc.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2013;144(3):959-965. doi:10.1378/chest.12-2572
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Background:  Heart rate (HR) and systolic BP (SBP) are significant 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 first follow-up of patients in the worst Q for change (Δ) in SBP since enrollment was 85% ± 2% (P = .004), 86% ± 2% for ΔHR (P = .12), and 84% ± 2% for ΔSBP/HR (P = .024) vs the middle three Qs (ΔSBP: 91% ± 1%; ΔHR: 90% ± 1%; ΔSBP/HR: 90% ± 1%).

Conclusions:  Changes in vital signs from enrollment to first follow-up were less predictive of mortality than the values of vital-sign parameters at either enrollment or first follow-up. HR, SBP, and SBP/HR at enrollment identified 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 defines the highest-risk group, including most of the high-risk patients defined by HR and SBP separately.

Trial registry:  ClinicalTrials.gov; No.: NCT00370214; URL: www.clinicaltrials.gov

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