Key result
In patients with HFpEF treated for hypertension, diastolic blood pressure <60 mm Hg was associated with an increased risk of heart failure hospitalization compared to ≥90 mm Hg (HR 2.12; 95% CI 1.20-3.74).
Why the study?
Is diastolic blood pressure associated with adverse outcomes in patients with heart failure with preserved ejection fraction treated for hypertension?
Cohort (n=1,703)
Yes
Is diastolic blood pressure associated with adverse outcomes in patients with heart failure with preserved ejection fraction treated for hypertension?
Hazard Ratio: 2.12 (95% CI 1.2–3.74)
p-value: p=0.0055 for trend
In patients with HFpEF treated for hypertension, DBP values <60 mm Hg and ≥90 mm Hg are associated with a significantly increased risk of adverse cardiovascular outcomes, suggesting a non-linear relationship.
May warrant caution with diastolic BP <60 mm Hg in HFpEF hypertension treatment; leaves optimal targets open for prospective trials.
Background Although diastolic blood pressure ( DBP ) is independently associated with an increased risk of adverse cardiovascular outcomes in the general population, it is unclear if a similar relationship exists in patients with heart failure with preserved ejection fraction. Methods and Results This analysis included 1703 (mean age, 72±10 years; 50% men; 78% white) patients with heart failure with preserved ejection fraction enrolled in the TOPCAT (Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist) Trial from the Americas who were treated for hypertension. Multivariable Cox regression was used to examine the risk of hospitalization for heart failure, death, and cardiovascular death associated with DBP . The relationship between hospitalization for heart failure and DBP was linear, with an increased risk observed with decreasing DBP values (≥90 mm Hg: referent; 80–89 mm Hg: hazard ratio [HR], 1.44; 95% confidence interval [CI], 0.85–2.44; 70–79 mm Hg: HR , 1.18; 95% CI , 0.69–2.01; 60–69 mm Hg: HR , 1.54; 95% CI , 0.90–2.63; <60 mm Hg: HR , 2.12; 95% CI , 1.20–3.74; P =0.0055 for trend). The associations of DBP with death (≥90 mm Hg: HR , 1.86; 95% CI , 1.12–3.06; 80–89 mm Hg: HR , 1.23; 95% CI , 0.89–1.70; 70–79 mm Hg: referent; 60–69 mm Hg: HR , 1.20; 95% CI , 0.90–1.59; <60 mm Hg: HR , 1.68; 95% CI , 1.21–2.33) and cardiovascular death (≥90 mm Hg: HR , 2.02; 95% CI , 1.10–3.71; 80–89 mm Hg: HR , 1.17; 95% CI , 0.77–1.79; 70–79 mm Hg: referent; 60–69 mm Hg: HR , 1.16; 95% CI , 0.80–1.70; <60 mm Hg: HR , 1.85; 95% CI , 1.21–2.82) were nonlinear, with a greater risk of each outcome observed with DBP values ≥90 and <60 mm Hg. Conclusions DBP values ≥90 and <60 mm Hg are associated with a significant risk of adverse outcomes in patients with heart failure with preserved ejection fraction who are treated for hypertension. Further research is needed to determine optimal DBP targets to reduce the risk of adverse events in patients with heart failure with preserved ejection fraction.
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Sandesara et al. (2018) conducted a cohort in Heart failure with preserved ejection fraction (HFpEF) treated for hypertension (n=1,703). Diastolic blood pressure <60 mm Hg vs. Diastolic blood pressure ≥90 mm Hg was evaluated on Hospitalization for heart failure (HR 2.12, 95% CI 1.20-3.74, p=0.0055 for trend). In patients with HFpEF treated for hypertension, diastolic blood pressure <60 mm Hg was associated with an increased risk of heart failure hospitalization compared to ≥90 mm Hg (HR 2.12; 95% CI 1.20-3.74).
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