June 28, 2026Journal of the American College of Cardiology18 citationsOpen Access
View Full PaperSystolic Blood Pressure and Pulse Pressure in Heart Failure
Key Result
Baseline systolic blood pressure ≥140 mm Hg was associated with a higher risk of heart failure hospitalization or cardiovascular death compared to 120-129 mm Hg (HR 1.22; 95% CI 1.10-1.34).
Key Points
- This study aimed to examine how baseline systolic blood pressure and pulse pressure affect cardiovascular outcomes in patients with heart failure with mildly reduced or preserved ejection fraction.
- Data pooled from I-PRESERVE, TOPCAT, PARAGON-HF, and DELIVER trials involving patients with heart failure and left ventricular ejection fraction ≥40%.
- Analyzed continuous baseline systolic blood pressure and pulse pressure concerning the primary endpoint using restricted cubic splines.
- Categorized systolic blood pressure into four groups and pulse pressure into quartiles to evaluate their prognostic impact on cardiovascular events.
- A total of 16,950 patients were included with mean systolic blood pressure of 131 mm Hg and mean pulse pressure of 55 mm Hg.
- A J-shaped relationship was identified between systolic blood pressure and cardiovascular risk, with the lowest risk at levels 120-130 mm Hg (HR: 1.22; 95% CI: 1.10-1.34).
- Similarly, pulse pressure showed a J-shaped association with the lowest risk at 50-60 mm Hg (HR: 1.22; 95% CI: 1.11-1.34).
Study Design
Type
Meta-Analysis (n=16,950)
Multicenter
Yes
Structured PICO
What is the prognostic impact of baseline systolic blood pressure and pulse pressure on cardiovascular outcomes in patients with HFmrEF or HFpEF?
P
Population
16,950 patients with HFmrEF or HFpEF from 4 global clinical trials, analyzed to determine the prognostic impact of baseline systolic blood pressure and pulse pressure.
E
Exposure
Baseline systolic blood pressure (SBP) and pulse pressure (PP) levels
C
Comparator
Reference categories: SBP 120-129 mm Hg and PP 46-54 mm Hg
O
Outcome
Composite of first heart failure hospitalization or cardiovascular deathcomposite
In patients with HFmrEF/HFpEF, both systolic blood pressure and pulse pressure exhibit a J-shaped relationship with cardiovascular risk, with the lowest risk observed at SBP 120-130 mm Hg and PP 50-60 mm Hg, supporting current guideline targets.
Main Result
Hazard Ratio: 1.22 (95% CI 1.1–1.34)
Abstract
BACKGROUND Hypertension is common in patients with heart failure with mildly reduced or preserved ejection fraction (HFmrEF/HFpEF), and current guidelines recommend treating systolic blood pressure (SBP) to a target 16,900 patients with HFmrEF/HFpEF, indicates a J-shaped relationship between both SBP and PP and cardiovascular risk. The lowest risk was observed at SBP levels between 120 and 130 mm Hg and PP values between 50 and 60 mm Hg (I-PRESERVE Irbesartan in Heart Failure With Preserved Systolic Function, NCT00095238; TOPCAT Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist, NCT00094302; PARAGON-HF Efficacy and Safety of LCZ696 Compared to Valsartan, on Morbidity and Mortality in Heart Failure Patients With Preserved Ejection Fraction, NCT01920711; DELIVER Dapagliflozin Evaluation to Improve the LIVEs of Patients With PReserved Ejection Fraction Heart Failure, NCT03619213).
Expert Takes1 quote
“In a pooled analysis of 16,950 patients with chronic HFmrEF or HFpEF enrolled from 4 global randomized clinical trials, a J-shaped relationship was observed between SBP and the risk of adverse CV events, with the lowest risk occurring at SBP values between 120.”
Dr. Akshay S. Desai, CardiologistBrigham and Women's Hospital, Harvard Medical Schoolgemini_groundedView source