Initiation of anti-hypertensive drugs and outcomes in patients with heart failure with preserved ejection fraction and persistent hypertension.

Abstract

BACKGROUND:

National heart failure (HF) guidelines recommend that in patients with HF with preserved ejection fraction (EF;HFpEF) and hypertension, systolic blood pressure (SBP) should be maintained below 130 mmHg. The objective of the study is to examine the association between initiation of anti-hypertensive drugs and outcomes in patients with HFpEF with persistent hypertension.

METHODS:

Of the 8873 hospitalized patients with HFpEF (EF ≥50%) with a history of hypertension without renal failure in Medicare-linked OPTIMIZE-HF, 3315 had a discharge SBP ≥130 mmHg, of whom 1971 were not receiving anti-hypertensive drugs, thiazides and calcium channel blockers, before hospitalization. Of these, 366 received discharge prescriptions for those drugs. We assembled a propensity score-matched cohort of 365 pairs of patients initiated and not initiated on anti-hypertensive drugs, balanced on 37 baseline characteristics. Hazard ratios (HR) and 95% confidence intervals (CI) for outcomes associated with anti-hypertensive drug initiation were estimated in the matched cohort.

RESULTS:

Matched patients (n = 730) had a mean age of 78 years; 67% were women and 17% African Americans. During 6 (median 2.5) years of follow-up, 66% of the patients died and 45% had HF readmission. HRs (95% CIs) for all-cause mortality at 30 days, 12 months and 6 years associated with anti-hypertensive drug initiation were 0.64 (0.30-1.36), 0.70 (0.51-0.97), and 0.95 (0.79-1.13), respectively. Respective HRs (95% CIs) for HF readmission were 1.65 (0.97-2.80), 1.18 (0.90-1.56) and 1.09 (0.88-1.35).

CONCLUSIONS:

Among hospitalized older patients with HFpEF with uncontrolled hypertension, the initiation of therapy with anti-hypertensive drugs was not associated with all-cause mortality or hospital readmission.

• Authors: Phillip H Lam, Apostolos Tsimploulis, Samir Patel, Venkatesh K Raman, Cherinne Arundel, Charles Faselis, Prakash Deedwania, Farooq H Sheikh, Sajal K Banerjee, Richard M Allman, Gregg C Fonarow, Wilbert S Aronow, Ali Ahmed
• Journal: Progress in cardiovascular diseases (Prog Cardiovasc Dis) 2022 Jul-Aug Vol. 73 Pg. 17-23 ISSN: 1873-1740 [Electronic] United States
• PMID: 35777433 (Publication Type: Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't, Research Support, U.S. Gov't, Non-P.H.S.)
• Copyright: Published by Elsevier Inc.

Chemical References

• Antihypertensive Agents

Topics

• Aged
• Antihypertensive Agents (adverse effects)
• Female
• Heart Failure (diagnosis, drug therapy, epidemiology)
• Humans
• Hypertension (diagnosis, drug therapy, epidemiology)
• Male
• Medicare
• Registries
• Stroke Volume (physiology)
• United States (epidemiology)