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. 2024 Jun 1;42(6):1048-1056.
doi: 10.1097/HJH.0000000000003693. Epub 2024 Feb 21.

Correlation between systolic blood pressure and mortality in heart failure patients with hypertension

Xueyan Lang  1   2 , Cheng Peng  1   2 , Yanxiu Zhang  1   2 , Rong Gao  1 , Bing Zhao  1   2 , Yilan Li  1   2 , Yao Zhang  1   2
Affiliations

Correlation between systolic blood pressure and mortality in heart failure patients with hypertension

Xueyan Lang et al. J Hypertens. .

Abstract

Background: The correlation between systolic blood pressure (SBP) and mortality in hypertensive patients with different phenotypes of heart failure (HF) has not been adequately studied, and optimal blood pressure control targets remain controversial. To explore the link between SBP and prognosis in all or three ejection fraction (EF) phenotypes of HF patients with hypertension.

Methods: We analyzed 1279 HF patients complicated by hypertension in a retrospective cohort. The SBP <130 mmHg group included 383 patients, and the SBP ≥130 mmHg group included 896 patients. The major end point was all-cause mortality.

Results: Of the 1279 study patients, with a median age of 66.0 ± 12.0 years, 45.3% were female. The proportions of the three subtypes of heart failure complicated with hypertension (HFrEF, HEmrEF, and HFpEF) were 26.8%, 29.3%, and 43.9%, respectively. During the 1-year follow-up, 223 patients experienced all-cause death, and 133 experienced cardiovascular death. Restricted cubic splines showed that the risk of all-cause and cardiovascular death increased gradually as the SBP level decreased in patients with HFrEF and HFmrEF. Furthermore, the multivariate Cox proportional hazards model revealed that SBP <130 mmHg was also associated with an increased risk of all-cause death [hazard ratio (HR) 2.53, 95% confidence interval (CI) 1.23-5.20, P = 0.011] and cardiovascular death (HR 1.91, 95% CI 1.01-3.63, P = 0.047) in HFrEF patients. A trend toward increased risk was observed among HFmrEF patients, but it was not statistically significant. This trend was not observed in HFpEF patients.

Conclusion: In HFrEF patients, SBP <130 mmHg was associated with an increased risk of all-cause and cardiovascular mortality. A trend toward increased risk was observed among HFmrEF patients, but not among HFpEF patients.

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Conflict of interest statement

The authors certify that they have no financial conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Flow chart of study participants. Patients were from the heart failure center of the Second Affiliated Hospital of Harbin Medical University from May 2018 to December 2019. HF, heart failure; LVEF, left ventricular ejection fraction; NT-proBNP, N-terminal pro brain natriuretic peptide; SBP, systolic blood pressure.
FIGURE 2
FIGURE 2
Restricted cubic spline fitting for the correlation between SBP levels and mortality across the spectrum of heart failure. HRs were evaluated by setting the SBP value = 130 mmHg as a reference. (a) All-cause mortality in HFrEF. (b) Cardiovascular mortality in HFrEF. (c) All-cause mortality in HFmrEF. (d) Cardiovascular mortality in HFmrEF. (e) All-cause mortality in HFpEF. (f) Cardiovascular mortality in HFpEF. HFmrEF, heart failure with mid-range ejection fraction; HFpEF, heart failure with preserved ejection fraction; HFrEF, heart failure with reduced ejection fraction; SBP, systolic blood pressure.
FIGURE 3
FIGURE 3
Kaplan–Meier curve analysis for the risk of mortality according to <130 mmHg vs. SBP ≥130 mmHg across the spectrum of heart failure. (a) All-cause mortality in HFrEF. (b) Cardiovascular mortality in HFrEF. (c) All-cause mortality in HFmrEF. (d) Cardiovascular mortality in HFmrEF. (e) All-cause mortality in HFpEF. (f) Cardiovascular mortality in HFpEF. HFmrEF, heart failure with mid-range ejection fraction; HFpEF, heart failure with preserved ejection fraction; HFrEF, heart failure with reduced ejection fraction; SBP, systolic blood pressure.
See this image and copyright information in PMC

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