Visit-to-Visit Blood Pressure Variability and Clinical Outcomes in Patients With Heart Failure With Preserved Ejection Fraction

Abstract

Whether visit-to-visit blood pressure variability (BPV) is associated with adverse outcomes in patients with heart failure (HF) with preserved ejection fraction is unclear. We assessed these associations in 3184 patients with HF (51.0% women; mean age, 68.6 years) with preserved ejection fraction (≥45%) enrolled in the TOPCAT trial (Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist). BPV indexes were the SD, variability independent of the mean, and average real variability. The primary end point consisted of total mortality, myocardial infarction, stroke, and hospitalized HF. We computed hazard ratios for the risks associated with 1-SD increase in BPV indexes, using multivariable Cox regression to adjust for the BP level and confounders. In the placebo group (n=1577), the primary composite end point, stroke, and hospitalized HF were significantly associated with systolic and diastolic BPV (hazard ratios, ≥1.28; P ≤0.008) and total mortality with systolic BPV (hazard ratios ≥1.20; P ≤0.010). In the spironolactone group (n=1607), the primary end point and hospitalized HF were associated with both systolic and diastolic BPV (hazard ratios ≥1.17; P ≤0.006). Sensitivity analyses stratified by sex, median age, and region generated confirmatory results. Most of the interactions between randomized group and BPV indexes were not significant. In conclusion, in patients with HF with preserved ejection fraction, greater systolic and diastolic BPV were associated with adverse health outcomes over and beyond the BP level.

Associations of short‐ and long‐term mortality with admission blood pressure in Chinese patients with different heart failure subtypes

“…The clinical significance of admission blood pressure might be different from blood pressure in chronic phase. 36 Furthermore, our study is distinguished by a relatively large sample size, the use of an EF ≥50% to define HFpEF, and consistent observations irrespective of adjustment for potential confounders, subgroup analyses, and sensitivity analyses. We also demonstrated that more drugs were used in the higher blood pressure group (Table 1 ), indicating lower blood pressure in this study might be the natural disease course or the consequence of the comorbidity rather than driven by more drug administration.…”

Increased mortality with intensive control in patients with higher baseline SBP and lower Framingham risk

“…Another intriguing observation from our study was that on-treatment SBP variability was higher among HBP/LRS patients receiving intensive treatment. Higher BP variability is known to be correlated with higher risk of adverse outcomes [31].…”

Association between visit‐to‐visit blood pressure variability and adverse events in coronary artery disease patients after coronary intervention

“… 23 , 24 visit‐to‐visit BPV is associated with events in patients with pre‐existing CAD, stroke, and heart failure suggesting that visit‐to‐visit BPV may have important roles in the secondary prevention of cardiovascular events as well. 25 , 26 , 27 …”

“…In the past two decades, visit‐to‐visit BPV has been repeatedly demonstrated to be an independent risk factor for all‐cause mortality, cardiovascular mortality, CAD incidence, and stroke incidence in the general population 23,24 . visit‐to‐visit BPV is associated with events in patients with pre‐existing CAD, stroke, and heart failure suggesting that visit‐to‐visit BPV may have important roles in the secondary prevention of cardiovascular events as well 25–27 …”