Charles Faselis1, Phillip H Lam2, Michael R Zile3, Poonam Bhyan4, Apostolos Tsimploulis5, Cherinne Arundel6, Samir Patel7, Peter Kokkinos7, Prakash Deedwania8, Deepak L Bhatt9, Qing Zeng-Trietler7, Charity J Morgan10, Wilbert S Aronow11, Richard M Allman12, Gregg C Fonarow13, Ali Ahmed14. 1. Veterans Affairs Medical Center, Washington, DC; George Washington University, Washington, DC; Uniformed Services University, Washington, DC. Electronic address: charles.faselis@va.gov. 2. Veterans Affairs Medical Center, Washington, DC; Georgetown University, Washington, DC; MedStar Washington Hospital Center, Washington, DC. 3. Medical University of South Carolina, Charleston; Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC. 4. Cape Fear Valley Medical Center, Fayetteville, NC; Department of Epidemiology, Johns Hopkins University, Baltimore, Md. 5. Stony Brook University Hospital, Stony Brook, NY. 6. Veterans Affairs Medical Center, Washington, DC; George Washington University, Washington, DC; Georgetown University, Washington, DC. 7. Veterans Affairs Medical Center, Washington, DC; George Washington University, Washington, DC. 8. Veterans Affairs Medical Center, Washington, DC; University of California, San Francisco. 9. Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, Mass. 10. Veterans Affairs Medical Center, Washington, DC; University of Alabama at Birmingham, Birmingham. 11. New York Medical College and Westchester Medical Center, Valhalla, NY. 12. George Washington University, Washington, DC; University of Alabama at Birmingham, Birmingham. 13. University of California, Los Angeles. 14. Veterans Affairs Medical Center, Washington, DC; George Washington University, Washington, DC; Georgetown University, Washington, DC. Electronic address: ali.ahmed@va.gov.
Abstract
BACKGROUND: New hypertension and heart failure guidelines recommend that systolic blood pressure (SBP) in patients with heart failure with preserved ejection fraction (HFpEF) and hypertension be lowered to <130 mm Hg. METHODS: Of the 6778 hospitalized patients with HFpEF and a history of hypertension in the Medicare-linked OPTIMIZE-HF registry, 3111 had a discharge SBP <130 mm Hg. Using propensity scores for SBP <130 mm Hg, we assembled a matched cohort of 1979 pairs with SBP <130 versus ≥130 mm Hg, balanced on 66 baseline characteristics (mean age, 79 years; 69% women; 12% African American). We then assembled a second matched cohort of 1326 pairs with SBP <120 versus ≥130 mm Hg. Hazard ratios (HRs) and 95% confidence intervals (CIs) for outcomes associated with SBP <130 and <120 mm Hg were separately estimated in the matched cohorts using SBP ≥130 mm Hg as the reference. RESULTS: HRs (95% CIs) for 30-day, 12-month, and 6-year all-cause mortality associated with SBP <130 mm Hg were 1.20 (0.91-1.59; P = 0.200), 1.11 (0.99-1.26; P = 0.080), and 1.05 (0.98-1.14; P = 0.186), respectively. Respective HRs (95% CIs) associated with SBP <120 mm Hg were 1.68 (1.21-2.34; P = 0.002), 1.28 (1.11-1.48; P = 0.001), and 1.11 (1.02-1.22; P = 0.022). There was no association with readmission. CONCLUSIONS: Among older patients with HFpEF and hypertension, compared with SBP ≥130 mm Hg, the new target SBP <130 mm Hg had no association with outcomes but SBP <120 mm Hg was associated with a higher risk of death but not of readmission. Future prospective studies need to evaluate optimal SBP treatment goals in these patients. Published by Elsevier Inc.
BACKGROUND: New hypertension and heart failure guidelines recommend that systolic blood pressure (SBP) in patients with heart failure with preserved ejection fraction (HFpEF) and hypertension be lowered to <130 mm Hg. METHODS: Of the 6778 hospitalized patients with HFpEF and a history of hypertension in the Medicare-linked OPTIMIZE-HF registry, 3111 had a discharge SBP <130 mm Hg. Using propensity scores for SBP <130 mm Hg, we assembled a matched cohort of 1979 pairs with SBP <130 versus ≥130 mm Hg, balanced on 66 baseline characteristics (mean age, 79 years; 69% women; 12% African American). We then assembled a second matched cohort of 1326 pairs with SBP <120 versus ≥130 mm Hg. Hazard ratios (HRs) and 95% confidence intervals (CIs) for outcomes associated with SBP <130 and <120 mm Hg were separately estimated in the matched cohorts using SBP ≥130 mm Hg as the reference. RESULTS: HRs (95% CIs) for 30-day, 12-month, and 6-year all-cause mortality associated with SBP <130 mm Hg were 1.20 (0.91-1.59; P = 0.200), 1.11 (0.99-1.26; P = 0.080), and 1.05 (0.98-1.14; P = 0.186), respectively. Respective HRs (95% CIs) associated with SBP <120 mm Hg were 1.68 (1.21-2.34; P = 0.002), 1.28 (1.11-1.48; P = 0.001), and 1.11 (1.02-1.22; P = 0.022). There was no association with readmission. CONCLUSIONS: Among older patients with HFpEF and hypertension, compared with SBP ≥130 mm Hg, the new target SBP <130 mm Hg had no association with outcomes but SBP <120 mm Hg was associated with a higher risk of death but not of readmission. Future prospective studies need to evaluate optimal SBP treatment goals in these patients. Published by Elsevier Inc.
Authors: Cherinne Arundel; Phillip H Lam; Gauravpal S Gill; Samir Patel; Gurusher Panjrath; Charles Faselis; Michel White; Charity J Morgan; Richard M Allman; Wilbert S Aronow; Steven N Singh; Gregg C Fonarow; Ali Ahmed Journal: J Am Coll Cardiol Date: 2019-06-25 Impact factor: 24.094
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Authors: Barry A Borlaug; Carolyn S P Lam; Véronique L Roger; Richard J Rodeheffer; Margaret M Redfield Journal: J Am Coll Cardiol Date: 2009-07-28 Impact factor: 24.094
Authors: Ali Ahmed; Michael W Rich; Michael Zile; Paul W Sanders; Kanan Patel; Yan Zhang; Inmaculada B Aban; Thomas E Love; Gregg C Fonarow; Wilbert S Aronow; Richard M Allman Journal: Am J Med Date: 2013-02 Impact factor: 4.965
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Authors: Senthil Selvaraj; Brian L Claggett; Michael Böhm; Stefan D Anker; Muthiah Vaduganathan; Faiez Zannad; Burkert Pieske; Carolyn S P Lam; Inder S Anand; Victor C Shi; Martin P Lefkowitz; John J V McMurray; Scott D Solomon Journal: J Am Coll Cardiol Date: 2020-03-16 Impact factor: 24.094