Background: According to 2017 update of 2013 ACCF/AHA HF guideline, systolic BP (SBP) should be lowered to <130 mmHg in euvolemic patients (pts) with HFpEF and persistent HTN. However, little is known about the role of high diastolic BP (DBP) on outcomes in these patients.
Methods: Of the 10482 hospitalized pts with decompensated HFpEF (EF >40%) discharged alive, 2652 had HTN, defined as SBP ≥140 or DBP ≥90 mmHg at both admission and discharge. Of these, 289 had a discharge DBP ≥90 mmHg. Propensity scores for DBP ≥90 mmHg, estimated for each of the 2652 pts, were used to assemble a cohort of 263 pairs of pts, with a discharge DBP ≥90 and <90 mmHg, balanced on 40 baseline characteristics including discharge SBP. The 526 matched pts (52% women, 24% African American) had mean (±SD) age of 74 (±13) years, EF of 56 (±8) %, and discharge DBP of 84 (±13) mmHg.
Results: During 6 (median, 3) years of follow-up, all-cause mortality occurred in 73% and 61% of matched pts with a discharge DBP ≥90 vs <90 mmHg, respectively (HR, 1.36; 95% CI, 1.10-1.67; p=0.004; Figure). HF readmission occurred in 54% and 43% of matched pts with DBP ≥90 vs <90 mmHg, respectively (HR, 1.37; 95% CI, 1.06-1.75; p=0.015). There was no association with all-cause readmission (HR, 1.05; 95% CI, 0.86-1.26).
Conclusion: About 1 in 10 hospitalized patients with HFpEF and HTN had a discharge DBP ≥90 mmHg, which was associated with a higher risk of mortality or morbidity.