Low diastolic blood pressure and adverse outcomes in heart failure with preserved ejection fraction

https://doi.org/10.1016/j.ijcard.2018.04.031Get rights and content
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Highlights

  • A low DBP was associated with higher risk of cardiovascular events in HFpEF patients.

  • A low SBP was not associated with cardiovascular event risks in HFpEF patients.

  • Further studies are needed to establish the appropriate BP targets in HFpEF patients.

Abstract

Background

It remains unknown whether a low diastolic blood pressure (DBP) increases the risks of cardiovascular events and death in patients with heart failure with preserved ejection fraction (HFpEF).

Methods

We used data from the TOPCAT trial. The primary outcome was a composite of all-cause death, non-fatal myocardial infarction, non-fatal stroke, or hospitalization for heart failure. Hazard ratios (HRs) were analyzed for DBPs of <60, 60–69, 70–79, and ≥90 mm Hg in comparison with a DBP of 80–89 mm Hg using multivariable Cox proportional hazard models.

Results

This study included 3417 patients with HFpEF who had a controlled blood pressure. In the mean follow-up period of 3.0 years, 881 patients experienced at least one confirmed primary outcome event. Compared with patients with a DBP of 80–89 mm Hg, the adjusted HRs for primary outcome events were significantly higher in those with DBPs of <60 mm Hg (HR: 2.19 [95% confidence interval,1.72–2.78]) and 60–69 mm Hg (HR: 1.52 [1.23–1.87]). Similarly, the adjusted HRs for all-cause death, major cardiovascular events, and hospitalization for heart failure, but not stroke, were significantly higher in patients with a DBP of <70 mm Hg. A relationship between a low DBP and adverse outcomes was found in HFpEF patients with a systolic blood pressure of ≥120 mm Hg; however, a low systolic blood pressure with a DBP of ≥70 mm Hg was not associated with these event risks.

Conclusions

A low DBP increased the risks of adverse outcomes in patients with HFpEF.

Abbreviations

HFpEF
heart failure with preserved ejection fraction
HFrEF
heart failure with reduced ejection fraction
BP
blood pressure
SBP
systolic blood pressure
DBP
diastolic blood pressure
TOPCAT
Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist
GFR
glomerular filtration rate
NHLBI
National Heart, Lung, and Blood Institute
NYHA
New York Heart Association
BMI
body mass index
HR
hazard ratio
CI
confidence interval
CAD
coronary artery disease

Keywords

Heart failure with preserved ejection fraction
Diastolic blood pressure
J-curve relationship
TOPCAT trial
Cardiovascular events
Mortality

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