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Lumped-Parameter and Finite Element Modeling of Heart Failure with Preserved Ejection Fraction
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Impact of left ventricular ejection function on blood pressure-lowering therapy in hypertensive patients with

Noriko Kikuchi1, Kentaro Jujo, Junichi Yamaguchi

  • 1Department of Cardiology, The Heart Institute of Japan, Tokyo Women's Medical University, Tokyo, Japan.

Journal of Hypertension
|February 17, 2016
PubMed

Insights

Hypertension treatment goals for patients with coronary artery disease should consider left ventricular ejection fraction (LVEF). Lower blood pressure targets may increase major adverse cardiac events in preserved LVEF patients.

Area of Science:

  • Cardiology
  • Hypertension Research
  • Clinical Outcomes

Background:

  • Hypertension and reduced left ventricular ejection fraction (LVEF) are associated with poorer prognosis.
  • The impact of LVEF on blood pressure (BP)-lowering therapy outcomes in hypertensive patients with coronary artery disease (CAD) is not well understood.

Purpose of the Study:

  • To investigate the influence of LVEF on clinical outcomes in hypertensive patients with CAD undergoing BP-lowering therapy.
  • To determine if LVEF status modifies the relationship between achieved systolic blood pressure (SBP) and major adverse cardiac events (MACE).

Main Methods:

  • Post hoc analysis of the Heart Institute of Japan Candesartan Randomized Trial for Evaluation in Coronary Heart Disease.
  • Included 1849 hypertensive patients with CAD and available LVEF data, categorized into reduced (<45%), intermediate (45-55%), and preserved (>55%) LVEF groups.
  • Analyzed MACE rates and the association between achieved SBP and MACE across LVEF groups.

Main Results:

  • MACE rates were highest in the reduced LVEF group (30.6%) and lowest in the preserved LVEF group (24.0%) over a median follow-up of 4.2 years.
  • A J-shaped association between achieved SBP and MACE was observed in the preserved LVEF group, with lower SBP (<120 mmHg) linked to increased MACE (HR 1.81).
  • This J-shaped association was not evident in the reduced or intermediate LVEF groups.

Conclusions:

  • LVEF status is a critical factor to consider when setting BP-lowering therapy goals in hypertensive patients with CAD.
  • Achieving very low SBP targets may be associated with increased MACE risk in patients with preserved LVEF.
Abstract

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