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Clinical Research Study| Volume 134, ISSUE 4, e252-e263, April 2021

Systolic Blood Pressure and Outcomes in Older Patients with HFpEF and Hypertension

Published:September 30, 2020DOI:https://doi.org/10.1016/j.amjmed.2020.08.030

      Abstract

      Background

      New hypertension and heart failure guidelines recommend that systolic blood pressure (SBP) in patients with heart failure with preserved ejection fraction (HFpEF) and hypertension be lowered to <130 mm Hg.

      Methods

      Of the 6778 hospitalized patients with HFpEF and a history of hypertension in the Medicare-linked OPTIMIZE-HF registry, 3111 had a discharge SBP <130 mm Hg. Using propensity scores for SBP <130 mm Hg, we assembled a matched cohort of 1979 pairs with SBP <130 versus ≥130 mm Hg, balanced on 66 baseline characteristics (mean age, 79 years; 69% women; 12% African American). We then assembled a second matched cohort of 1326 pairs with SBP <120 versus ≥130 mm Hg. Hazard ratios (HRs) and 95% confidence intervals (CIs) for outcomes associated with SBP <130 and <120 mm Hg were separately estimated in the matched cohorts using SBP ≥130 mm Hg as the reference.

      Results

      HRs (95% CIs) for 30-day, 12-month, and 6-year all-cause mortality associated with SBP <130 mm Hg were 1.20 (0.91–1.59; P = 0.200), 1.11 (0.99–1.26; P = 0.080), and 1.05 (0.98–1.14; P = 0.186), respectively. Respective HRs (95% CIs) associated with SBP <120 mm Hg were 1.68 (1.21–2.34; P = 0.002), 1.28 (1.11–1.48; P = 0.001), and 1.11 (1.02–1.22; P = 0.022). There was no association with readmission.

      Conclusions

      Among older patients with HFpEF and hypertension, compared with SBP ≥130 mm Hg, the new target SBP <130 mm Hg had no association with outcomes but SBP <120 mm Hg was associated with a higher risk of death but not of readmission. Future prospective studies need to evaluate optimal SBP treatment goals in these patients.

      Keywords

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