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Randomized Controlled Trial
. 2022 Apr 5;11(7):e022765.
doi: 10.1161/JAHA.121.022765. Epub 2022 Mar 15.

Time in Target Range for Systolic Blood Pressure and Cardiovascular Outcomes in Patients With Heart Failure With Preserved Ejection Fraction

Rihua Huang  1   2 , Yifen Lin  1   2 , Menghui Liu  1   2 , Zhenyu Xiong  1   2 , Shaozhao Zhang  1   2 , Xiangbin Zhong  1   2 , Xiaomin Ye  1   2 , Yiquan Huang  1   2 , Xiaodong Zhuang  1   2 , Xinxue Liao  1   2
Affiliations
Randomized Controlled Trial

Time in Target Range for Systolic Blood Pressure and Cardiovascular Outcomes in Patients With Heart Failure With Preserved Ejection Fraction

Rihua Huang et al. J Am Heart Assoc. .

Abstract

Background The association between blood pressure control and clinical outcomes is unclear among patients with heart failure with preserved ejection fraction. Both too high and too low of systolic blood pressure (SBP) have been reported to be related to poor clinical prognosis. This study aimed to assess the association between time in SBP target range and adverse clinical events among patients with heart failure with preserved ejection fraction. Methods and Results This study was a secondary analysis of the TOPCAT (Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist) trial, a randomized clinical trial that compared the efficacy and safety of spironolactone in patients with heart failure with preserved ejection fraction. Time in target range (TTR) was calculated using linear interpolation, with the target range of SBP defined as 110 to 130 mm Hg. The association between TTR with adverse outcomes was estimated using multivariable Cox regression to adjust for multiple confounders. Participants with greater TTR were younger, more likely to be White, had less comorbidities, and lower body mass index. After adjusting for multiple covariates including mean SBP, 1-SD increment (38.3%) of TTR was significantly associated with a decreased risk of primary composite end point (hazard ratio [HR], 0.81 [0.73-0.90]), as well as a lower risk of all-cause mortality (HR, 0.81 [0.73-0.90]), cardiovascular death (HR, 0.78 [0.68-0.90]), and heart failure hospitalization (HR, 0.85 [0.74-0.97]). Results were similar when participants were categorized by TTR groups. Subgroup analyses showed that the associations were more significant in young people than in the old (Pinteraction=0.028). Conclusions In patients with heart failure with preserved ejection fraction, greater time in SBP target range was statistically associated with a decreased risk of cardiovascular outcomes and mortality events beyond blood pressure level, especially among younger patients.

Keywords: blood pressure; heart failure; time in target range.

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Figures

Figure 1
Figure 1. Diagram of time in systolic blood pressure (SBP) target range and stacked bar graphs of mean SBP by time in target range groups.
This figure depicts example of low to high time in SBP target range (A). Participants with higher time in SBP target range tend to have a greater proportion for which the mean SBP was within the target range (B). SBP indicates systolic blood pressure; and TTR, time in target range.
Figure 2
Figure 2. Restricted cubic spline plots for primary end point by time in systolic blood pressure target range.
The figure showed the adjusted hazard ratios of primary end point by time in systolic blood pressure target range. Each hazard ratio was compared with a median time in target range of 53.3%. The blue line represents the hazard ratio of time in systolic blood pressure target range across the whole range. The red lines represent the 95% CI.
Figure 3
Figure 3. Pre‐specified subgroups analyses of the association between time in systolic blood pressure target range and primary composite end point.
In this forest plot, circles represent the value of hazard ratio, and bars represent the 95% CI. BMI indicates body mass index; CKD, chronic kidney disease; NYHA, New York Heart Association; and SBP, systolic blood pressure.
See this image and copyright information in PMC

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