Abstract FR487: Impact of Hypertension on Outcomes in Cardiac Amyloidosis: Trends in Heart Failure, Mortality, and Arrhythmias Compared to Non-Hypertensive Cases

Introduction: Patients with cardiac amyloidosis (CA) may have concomitant hypertension (HTN) that has an impact on their long-term mortality and morbidity. However, there is seldom evidence of HTN cardiovascular outcomes on CA. Hypothesis: We compared cardiovascular outcomes of HTN in patients with CA. Methodology: This retrospective cohort study using TriNetX Global Collaborative Network analyzed patients aged ≥18 years from 1/1/2007 to 5/25/2025. After 1:1 propensity score matching, cohort 1 CA + HTN (n=4,197), while cohort 2 CA-only (n=4,197) were formed. Study population mean age was 71 years (70% male, 28% female, 2% unknown sex). Primary and secondary outcomes evaluated were all-cause mortality, heart failure (HF), atrial fibrillation (AF), ventricular tachycardia (VT), and ventricular fibrillation (VF). We calculated odds ratio (OR), hazard ratio (HR), 95% confidence interval (CI) and p-value using TrinetX platform. Results: All-cause mortality was significantly lower in the CA+HTN group (26.8%) compared to the CA-only group (31.1%) with an OR of 0.811 (95% CI: 0.738–0.891), HR 0.671 (95% CI: 0.619–0.727), and p<0.0001. However, the CA+HTN group showed a higher incidence of HF (69.4% vs 57.4%; OR: 1.682, 95% CI: 1.538–1.840, HR: 1.163, 95% CI: 1.102–1.227, p<0.0001), AF (49.6% vs 38.9%; OR: 1.546, 95% CI: 1.417–1.686, HR: 1.180, 95% CI: 1.106–1.259, p<0.0001), and VT (13.8% vs 9.8%; OR: 1.484, 95% CI: 1.297–1.698, HR: 1.189, 95% CI: 1.047–1.349, p=0.0074). No significant difference was observed in VF (1.10% vs 1.12%; OR: 0.978, 95% CI: 0.650–1.473, HR: 0.800, 95% CI: 0.532–1.202, p=0.2814). Conclusion: Among patients with CA, coexisting HTN is associated with lower all-cause mortality and longer survival, possibly due to earlier detection and milder disease at diagnosis. However, these patients face a higher risk of HF and arrhythmias, such as AF and VT. HTN seems to have some degree of survival benefit when present with CA, though cardiovascular morbidity increases.