Higher Blood Pressure Associated With Better Survival in Pulmonary Hypertension

This multicenter cohort study used the Pulmonary Vascular Research Institute GoDeep meta-registry to assess survival among 12,771 patients with incident pulmonary hypertension diagnosed by right heart catheterization. The cohort included patients across pulmonary hypertension groups 1–5 and all age categories; median age was 65 years and 58% were female. Researchers examined diagnosed systemic hypertension, baseline systolic systemic arterial pressure (sSAP) and heart rate, as well as changes in these measures over time. All-cause mortality was analyzed using adjusted Cox models, with external validation in a separate UK cohort.

After adjustment for factors including age, pulmonary hypertension group, medications and cardiac index, patients with systemic hypertension had a 26% lower mortality hazard than those without hypertension (hazard ratio, 0.74; 95% CI, 0.68–0.79). Higher baseline sSAP, across values from 80 to 180 mm Hg, was associated with better survival. Higher heart rate and declining sSAP during follow-up were associated with higher mortality. Findings were consistent across pulmonary hypertension and age groups and were confirmed in the UK cohort.

The study reports associations, not evidence that raising blood pressure improves outcomes or that antihypertensive treatment should be changed. Its retrospective and prospective registry data may not establish causality, despite adjustment and external validation.