Early drop in systolic blood pressure and worsening renal function in acute heart failure: Renal results of Pre-RELAX-AHF

Adriaan A. Voors*, Beth A. Davison, G. Michael Felker, Piotr Ponikowski, Elaine Unemori, Gadi Cotter, John R. Teerlink, Barry H. Greenberg, Gerasimos Filippatos, Sam L. Teichman, Marco Metra, S. L. Teichman, B. M. Massie, S. Goldstein, M. Bohm, G. Francis, C. E. Davis, S. Boldueva, V. Moiseev, Z. ShogenovM. Ruda, A. Vishnevsky, M. Boyarkin, V. Simanenkov, S. Tereschenko, Y. Shwartz, O. Orlikova, M. Arkhipov, I. Libov, R. Sardinov, A. Suvorov, A. Marmor, A. Katz, R. Zimlichman, M. Omary, R. Hershkoviz, S. Goland, A. Keren, D. Aronson, J. Grzybowski, W. Musial, D. Apró, G. Lupkovics, C. Stamate, A. Salajan, A. Matei, P. Levy, P. Pang, S. Collins, D. Gupta, W. Van Mieghem, L. Muyldermans, G. Vervoort

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

99 Scopus citations


Aims We aimed to determine the relation between baseline systolic blood pressure (SBP), change in SBP, and worsening renal function (WRF) in acute heart failure (AHF) patients enrolled in the Pre-RELAX-AHF trial. Methods and resultsThe Pre-RELAX-AHF study enrolled 234 patients within 16 h of admission (median 7 h) for AHF and randomized them to relaxin given intravenous (i.v.) for 48 h or placebo. Blood pressure was measured at baseline, at 3, 6, 9, 12, 24, 36, and 48 h and at 3, 4, and 5 days after enrolment. Worsening renal function was defined as a serum creatinine increase of <0.3 mg/dL by Day 5. Worsening renal function was found in 68 of the 225 evaluable patients (30). Patients with WRF were older (73.5 ± 9.4 vs. 69.1 ± 10.6 years; P 0.003), had a higher baseline SBP (147.3 ± 19.9 vs. 140.8 ± 16.7 mmHg; P 0.01), and had a greater early drop in SBP (37.9 ± 16.0 vs. 31.4 ± 12.2 mmHg; P 0.004). In a multivariable model, higher age, higher baseline creatinine, and a greater early drop in SBP, but not baseline SBP, remained independent predictors of WRF. Furthermore, WRF was associated with a higher Day 60 (P 0.01), and Day 180 (P 0.003) mortality. ConclusionsWorsening renal function in hospitalized AHF patients is related to a poor clinical outcome and is predicted by a greater early drop in SBP.

Original languageEnglish
Pages (from-to)961-967
Number of pages7
JournalEuropean Journal of Heart Failure
Issue number9
StatePublished - 1 Sep 2011


  • Acute heart failure
  • Blood pressure
  • Creatinine
  • Mortality
  • Renal function


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