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

Tetsuro Tsujimoto1, Hiroshi Kajio1

  • 1Department of Diabetes, Endocrinology, and Metabolism, Center Hospital, National Center for Global Health and Medicine, Tokyo, Japan.

International Journal of Cardiology
|April 18, 2018
PubMed

Insights

Low diastolic blood pressure (DBP) significantly increases cardiovascular risks in heart failure with preserved ejection fraction (HFpEF) patients. This finding highlights the importance of monitoring DBP for adverse outcomes in this population.

Area of Science:

  • Cardiology
  • Clinical Research
  • Hypertension Management

Background:

  • The prognostic implications of low diastolic blood pressure (DBP) in patients with heart failure with preserved ejection fraction (HFpEF) remain unclear.
  • Existing research has not definitively established whether reduced DBP poses a risk for cardiovascular events or mortality in this specific patient group.

Purpose of the Study:

  • To investigate the association between low diastolic blood pressure (DBP) and the risk of cardiovascular events and death in patients diagnosed with heart failure with preserved ejection fraction (HFpEF).

Main Methods:

  • Utilized data from the Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist (TOPCAT) trial.
  • Analyzed a composite primary outcome including all-cause death, non-fatal myocardial infarction, non-fatal stroke, or hospitalization for heart failure.
  • Employed multivariable Cox proportional hazard models to assess hazard ratios (HRs) for different DBP categories (<60, 60-69, 70-79, and ≥90 mmHg) compared to a reference range (80-89 mmHg).

Main Results:

  • The study included 3417 HFpEF patients with controlled blood pressure; 881 experienced primary outcome events during a 3.0-year follow-up.
  • Significantly higher adjusted HRs for primary outcome events were observed in patients with DBP <60 mmHg (HR: 2.19) and 60-69 mmHg (HR: 1.52) compared to the 80-89 mmHg reference group.
  • Low DBP (<70 mmHg) was associated with increased risks of all-cause death, major cardiovascular events, and heart failure hospitalizations, but not stroke. This association was evident in HFpEF patients with systolic blood pressure ≥120 mmHg.

Conclusions:

  • A low diastolic blood pressure (DBP) is a significant risk factor for adverse cardiovascular outcomes in patients with heart failure with preserved ejection fraction (HFpEF).
  • The findings underscore the clinical importance of considering DBP thresholds in risk stratification and management strategies for HFpEF patients.
Abstract

Keywords:
Cardiovascular eventsDiastolic blood pressureHeart failure with preserved ejection fractionJ-curve relationshipMortalityTOPCAT trial

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