Key result
High visit-to-visit systolic BP variability in HFpEF linked to ~63% greater risk of major events.
Why the study?
Studies had not fully explored the association between blood pressure variability and adverse clinical outcomes in patients with HFpEF.
Does high visit-to-visit variability of systolic blood pressure increase the risk of adverse cardiovascular outcomes in patients with HFpEF?
Cohort (n=1,988)
Does high visit-to-visit variability of systolic blood pressure increase the risk of adverse cardiovascular outcomes in patients with HFpEF?
Effect estimate: HR 1.63 (95% CI 1.07-2.49)
p-value: p=0.024
High visit-to-visit variability of systolic blood pressure is associated with an increased risk of adverse cardiovascular outcomes in patients with HFpEF, independent of mean blood pressure.
Should not yet change HFpEF practice; supports prospective trials on BP variability as a modifiable risk marker.
AIMS: Previous studies report that blood pressure (BP) variability is associated with increased risk of adverse outcomes in patients diagnosed with cardiovascular disease. However, studies have not fully explored this association in patients with heart failure with preserved ejection fraction (HFpEF). This study sought to explore the association between visit-to-visit variability (VVV) of BP and clinical outcomes in patients with HFpEF. METHODS AND RESULTS: A total of 1988 patients (mean age of 67.73 ± 9.22, 51.7% female) from the Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist (TOPCAT) trial were included in this study. BP-VVV was determined by standard deviation (SD) of mean systolic BP (SBP-SD) from six measurements (baseline and months 1, 2, 4, 8, and 12) during the first 12 months after randomization. Mean on-treatment SBP during the first 12 months was 127.77 ± 10.42 mmHg, and the median of SBP-SD was 8.15 mmHg. A total of 192 (9.7%) patients met the primary outcome during the subsequent median follow-up of 35.16 months, including a composite of cardiovascular death, heart failure hospitalization, or aborted cardiac arrest. Multiple Cox regression analysis showed that SBP-SD was independently associated with the increased risk of the primary outcome after adjusting for age, gender, method of BP measurement, treatment, renal function and common co-morbidities, and the mean SBP during the first 12 months [hazard ratio (HR) for fourth vs. first quartile, 1.63; 95% confidence interval (CI), 1.07-2.49; P = 0.024]. Analysis showed that SBP-SD as continuous variable was associated with a 23% increase in the risk of primary outcome (HR 1.23, 95% CI 1.06-1.43; P = 0.006). CONCLUSIONS: The findings of the current study show that high SBP-VVV in patients with HFpEF is associated with an increased risk of adverse outcomes independent of the mean on-treatment SBP.
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Zhang et al. (2021) conducted a cohort in Heart failure with preserved ejection fraction (HFpEF) (n=1,988). High systolic blood pressure visit-to-visit variability vs. Low systolic blood pressure visit-to-visit variability (first quartile) was evaluated on Composite of cardiovascular death, heart failure hospitalization, or aborted cardiac arrest (HR 1.63, 95% CI 1.07-2.49, p=0.024). High systolic blood pressure visit-to-visit variability in HFpEF increased the risk of CV death, HF hospitalization, or aborted cardiac arrest (HR 1.63; 95% CI 1.07-2.49; P=0.024).
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