Prognostic impact of systolic blood pressure in acute heart failure with preserved ejection fraction in older patients

Abstract

Aims Recent guidelines recommend a systolic blood pressure (SBP) target below 130 mmHg in heart failure patients with preserved ejection fraction (HFpEF), whatever their age. We investigated whether this intensive SBP control was associated with better survival in very old adults hospitalized for acute HFpEF. Methods and resultsWe conducted an observational study in an acute geriatric unit: all consecutive patients discharged from hospital for acute heart failure from 1 March 2019 to 29 February 2020 with a diagnosis of HFpEF were included. Re-hospitalization and all-cause mortality at 1 year were compared according to the mean SBP at discharge (patients with a mean SBP < 130 mmHg vs. those with SBP ≥ 130 mmHg). We included 81 patients with a mean age of 89 years. Among them, 47 (58%) were re-hospitalized and 37 (46%) died at 1 year. All-cause mortality (hazard ratio [HR] [95% confidence interval]: 1.50 [0.75-2.98], P = 0.2) and re-hospitalization rate (HR: 1.04 [0.58-1.86], P = 0.90) at 1 year did not significantly differ between patients with SBP ≥ 130 mmHg and those with SBP < 130 mmHg at discharge. However, a prescription for antihypertensive drugs at discharge was associated with a better long-term prognosis (all-cause mortality: HR: 0.42 [0.20-0.88], P = 0.02; re-hospitalization rate: HR: 0.56 [0.28-1.10], P = 0.09). Conclusions Although SBP < 130 mmHg at discharge was not associated with a better prognosis among very old patients hospitalized for acute HFpEF, the prescription of antihypertensive drugs was associated with mortality and re-hospitalization rates that were reduced by half. Future prospective studies are needed to assess target blood pressure in very elderly patients with HFpEF.

Triglyceride Glucose Index as a Predictor of 30-Day Readmission and 6 Months Mortality After Hospitalization in Acute Decompensated Heart Failure

“…contrast, low or even normal BP at presentation, which may be the goal of treatment in the ambulatory setting, maybe a more ominous finding, reflecting a low cardiac output and suboptimal or inadequate end-organ perfusion, including coronary hypoperfusion, thereby worsening the heart failure condition. 12 Triglyceride levels of 150 mg/dL had an 81% higher risk for 30-day hospital readmission in ADHF patients. The association may be direct, indirect, or both.…”

Blood pressure levels and adverse cardiovascular outcomes in heart failure: A systematic review and meta‐analysis

“…Ninety articles were excluded based on the following reasons: irrelevant exposure ( n = 69), follow‐up inadequate ( n = 16), duplicate study ( n = 1), data not extractable ( n = 1), irrelevant outcome ( n = 1), and irrelevant population ( n = 2). The remaining 44 articles were eligible and included in the review 8,9,25–66 …”

“…The studies were published between 1999 and 2022 ( Table 1 ). 8,9,25–66 The geographic distribution was 21 studies in Asia (China, Iran, Israel, Japan, Republic of Korea and Taiwan), 10 in Europe (France, Germany, Italy, Spain, Sweden and UK), and 11 in North America (Canada and USA) and 1 study in South America (Brazil). The participants' average baseline age ranged from 52 to 89 years, with a weighted mean of 74 years.…”

Sympathomodulation in Heart Failure with High vs. Normal Ejection Fraction

“…In these patients, evidence-based and clinically effective treatment options for BP reduction are rare, which usually results in poor cardiovascular outcome. 18 Although effects of BP control on mortality in HFpEF have not been proven yet, data from smaller studies suggests improved outcome with antihypertensive treatment, 19 and current guidelines support optimal treatment of hypertension in HFpEF. 2 In line with a previous retrospective study, 20 both groups show an increased AAD at follow-up, likely through a lower sympathetic tone after RDN.…”