Key result
Hypertension in HFrEF linked to ~8% lower mortality, driven by nonischemic etiology.
Why the study?
Hypertension is a common comorbidity in patients with HFrEF, yet its prognostic significance across ischemic and nonischemic etiologies remains complex.
Cohort (n=11,242)
No
In patients with HFrEF, a history of hypertension is independently associated with improved survival specifically among those with a nonischemic etiology, whereas it has no significant adjusted mortality impact in those with ischemic heart disease.
Hypertension history should not guide HFrEF therapy; leaves open etiology-specific prognostic associations in nonischemic patients.
BACKGROUND: Hypertension (HTN) is a common comorbidity in patients with heart failure with reduced ejection fraction (HFrEF), yet its prognostic significance remains complex. OBJECTIVE: To evaluate the association between HTN and all-cause mortality in patients with HFrEF, stratified by ischemic and nonischemic etiologies. METHODS: This retrospective cohort study included 11 242 patients with HFrEF treated between January 2009 and October 2025 at a national tertiary referral center. Patients were categorized according to ischemic vs. nonischemic etiology. The primary outcome was all-cause mortality. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using Cox proportional hazards models, with multivariable adjustment for baseline characteristics. RESULTS: HTN was present in 6992 patients (62%), and 6963 (63%) had ischemic heart disease (IHD). During a median follow-up of 5.0 years, 4952 patients (44%) died. Crude mortality was higher among hypertensive patients (46% vs. 41%, P < 0.001). In univariate analysis, HTN was associated with increased mortality risk (HR 1.24, 95% CI 1.17-1.30, P < 0.001). However, after multivariable adjustment, HTN was associated with a reduction in mortality (HR 0.92, 95% CI 0.87-0.97, P = 0.004). Stratified analysis demonstrated that this protective association was confined to patients without IHD (HR 0.84, 95% CI 0.77-0.92, P < 0.001), while no significant association was observed in those with IHD (HR 0.99, 95% CI 0.92-1.06). CONCLUSION: In patients with HFrEF, HTN is associated with reduced mortality only in those with nonischemic etiology.
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Zango et al. (2026) conducted a cohort in Heart failure with reduced ejection fraction (HFrEF) (n=11,242). History of hypertension vs. No history of hypertension was evaluated on All-cause mortality (HR 0.92, 95% CI 0.87-0.97, p=0.004). Hypertension in HFrEF was associated with lower adjusted mortality overall (HR 0.92; 95% CI 0.87-0.97; P=0.004), driven by nonischemic patients (HR 0.84; 95% CI 0.77-0.92; P<0.001).
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