Assessing cardiovascular benefits of intensive blood pressure lowering in high‐risk undiagnosed HFpEF patients

Abstract Aims Heart failure with preserved ejection fraction (HFpEF) is often underdiagnosed. This study evaluates the HFpEF‐ABA score's ability to identify high‐risk, undiagnosed HFpEF subgroups with elevated cardiovascular event rates and assesses the impact of intensive blood pressure control in these populations. Methods A post‐hoc analysis of the Systolic Blood Pressure Intervention Trial (SPRINT) was performed. The HFpEF‐ABA score identified high‐risk individuals with undiagnosed HFpEF. Cox proportional hazards regression was used to examine interactions between HFpEF‐ABA score groups and intensive blood pressure control on major cardiovascular outcomes. The primary outcome was a composite of myocardial infarction (MI), acute coronary syndrome not resulting in MI, stroke, acute decompensated heart failure and cardiovascular disease death. Results Among 9265 patients (mean age, 67.9 ± 9.4 years; 35.5% females), 559 primary outcomes occurred during a median follow‐up of 3.2 years. An HFpEF‐ABA score ≥ 90% was associated with a higher risk of the primary outcome adjusted hazard ratio (aHR), 1.96 (1.57–2.44); P < 0.001. When treated as a continuous variable, higher HFpEF‐ABA scores were independently associated with an increased risk of the primary composite outcome ( P = 0.001), with a modest non‐linear relationship observed ( P for non‐linearity = 0.040). In the intensive treatment group, the absolute reduction in primary outcomes was 5.0 per 1000 patient‐years for scores < 90% and 11.2 per 1000 patient‐years for ≥ 90%. Intensive blood pressure control reduced primary outcomes in both groups <90%: aHR, 0.75 (0.62–0.90); ≥90%: aHR, 0.76 (0.51–1.13) with no significant heterogeneity ( P for interaction = 0.944). Serious adverse events did not increase in either group <90%: aHR, 1.04 (0.96–1.11); ≥90%: aHR, 1.06 (0.88–1.28); P for interaction = 0.801. Conclusions The HFpEF‐ABA score identifies high‐risk patients with undiagnosed HFpEF who have elevated cardiovascular event rates and benefit from intensive blood pressure control without an increased risk of serious adverse events.