Background: According to 2017 update of 2013 ACCF/AHA HF guideline, SBP should be lowered to <130 mmHg in euvolemic patients with HFpEF and persistent HTN.
Methods: In Medicare-linked OPTIMIZE-HF registry, 10482 hospitalized patients with decompensated HFpEF (EF >40%) were discharged alive and considered stable. HTN was defined as SBP ≥140 mmHg or DBP ≥90 mmHg (both admission and discharge), or if BP was normal (SBP <140 and DBP <90 mmHg), by use of anti-HTN drugs (both admission and discharge), defined as use of calcium channel blockers, hydralazine, or both ACE inhibitors/ARBs and beta-blockers. Of the 5514 patients with HTN, 1810 had a discharge SBP <130 mmHg. Propensity scores for SBP <130 mmHg, estimated for each of the 5514 patients, were used to assemble a cohort of 1719 pairs of patients, with a discharge SBP <130 vs ≥130 mmHg, who were balanced on 36 baseline characteristics. The 3438 matched patients (66% women, 10% African American) had mean (±SD) age of 78 (±10) years, EF of 57 (±8) %, and discharge SBP of 132 (±22) mmHg.
Results: During 6 (median, 3) years of follow-up, all-cause mortality occurred in 68% and 66% of matched patients with a discharge SBP <130 vs ≥130 mmHg, respectively (HR, 1.07; 95% CI, 0.99-1.16; p=0.106; Figure). All-cause readmission occurred in 90% and 91% of matched patients with SBP <130 vs ≥130 mmHg, respectively (HR, 1.11; 95% CI, 0.97-1.26; p=0.129). Respective rates for HF readmission were 47% and 48% (HR, 1.02; 95% CI, 0.92-1.12; p=0.725). Similar associations were observed during 1 year follow-up.
Conclusion: In patients with HFpEF and HTN, a discharge SBP of <130 mmHg was not significantly associated with mortality or morbidity.