Bharathi Upadhya1, James J Willard2, Laura C Lovato2, Michael V Rocco3, Cora E Lewis4, Suzanne Oparil5, William C Cushman5,6, Jeffrey T Bates7, Natalie A Bello8, Gerard Aurigemma9, Karen C Johnson10, Carlos J Rodriguez11, Dominic S Raj12, Anjay Rastogi13, Leonardo Tamariz14,15, Alan Wiggers16, Dalane W Kitzman1. 1. Cardiovascular Medicine Section (B.U., D.W.K.), Wake Forest School of Medicine, Winston-Salem, NC. 2. Biostatistics (J.J.W., L.C.L.), Wake Forest School of Medicine, Winston-Salem, NC. 3. Nephrology Section, Department of Internal Medicine (M.V.R.), Wake Forest School of Medicine, Winston-Salem, NC. 4. Department of Epidemiology, School of Public Health (C.E.L.), University of Alabama at Birmingham. 5. Division of Cardiovascular Disease, Department of Medicine (S.O.), University of Alabama at Birmingham. 6. Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis (W.C.C.). 7. Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, TX (J.T.B.). 8. Cardiovascular Division, Department of Medicine, Columbia University Medical Center, New York, NY (N.A.B.). 9. Cardiology, University of Massachusetts Medical School, Worcester (G.A.). 10. Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis (K.C.J.). 11. Department of Medicine, Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY (C.J.R.). 12. Medicine-Nephrology, George Washington University School of Medicine, Washington, DC (D.S.R.). 13. Division of Nephrology, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles (A.R.). 14. University of Miami Miller School of Medicine, FL (L.T.). 15. Veterans Affairs Medical Center, Miami, FL (L.T.). 16. University Hospitals Harrington Heart and Vascular Institute, Cleveland Medical Center, OH (A.W.).
Abstract
BACKGROUND: In the SPRINT (Systolic Blood Pressure Intervention Trial), intensive BP treatment reduced acute decompensated heart failure (ADHF) events. Here, we report the effect on HF with preserved ejection fraction (HFpEF) and HF with reduced EF (HFrEF) and their subsequent outcomes. METHODS: Incident ADHF was defined as hospitalization or emergency department visit, confirmed, and formally adjudicated by a blinded events committee using standardized protocols. HFpEF was defined as EF ≥45%, and HFrEF was EF <45%. RESULTS: Among the 133 participants with incident ADHF who had EF assessment, 69 (52%) had HFpEF and 64 (48%) had HFrEF (P value: 0.73). During average 3.3 years follow-up in those who developed incident ADHF, rates of subsequent all-cause and HF hospital readmission and mortality were high, but there were no significant differences between those who developed HFpEF versus HFrEF. Randomization to the intensive arm had no effect on subsequent mortality or readmissions after the initial ADHF event, irrespective of EF subtype. During follow-up among participants who developed HFpEF, although relatively modest number of events limited statistical power, age was an independent predictor of all-cause mortality, and Black race independently predicted all-cause and HF hospital readmission. CONCLUSIONS: In SPRINT, intensive BP reduction decreased both acute decompensated HFpEF and HFrEF events. After initial incident ADHF, rates of subsequent hospital admission and mortality were high and were similar for those who developed HFpEF or HFrEF. Randomization to the intensive arm did not alter the risks for subsequent all-cause, or HF events in either HFpEF or HFrEF. Among those who developed HFpEF, age and Black race were independent predictors of clinical outcomes. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT01206062.
BACKGROUND: In the SPRINT (Systolic Blood Pressure Intervention Trial), intensive BP treatment reduced acute decompensated heart failure (ADHF) events. Here, we report the effect on HF with preserved ejection fraction (HFpEF) and HF with reduced EF (HFrEF) and their subsequent outcomes. METHODS: Incident ADHF was defined as hospitalization or emergency department visit, confirmed, and formally adjudicated by a blinded events committee using standardized protocols. HFpEF was defined as EF ≥45%, and HFrEF was EF <45%. RESULTS: Among the 133 participants with incident ADHF who had EF assessment, 69 (52%) had HFpEF and 64 (48%) had HFrEF (P value: 0.73). During average 3.3 years follow-up in those who developed incident ADHF, rates of subsequent all-cause and HF hospital readmission and mortality were high, but there were no significant differences between those who developed HFpEF versus HFrEF. Randomization to the intensive arm had no effect on subsequent mortality or readmissions after the initial ADHF event, irrespective of EF subtype. During follow-up among participants who developed HFpEF, although relatively modest number of events limited statistical power, age was an independent predictor of all-cause mortality, and Black race independently predicted all-cause and HF hospital readmission. CONCLUSIONS: In SPRINT, intensive BP reduction decreased both acute decompensated HFpEF and HFrEF events. After initial incident ADHF, rates of subsequent hospital admission and mortality were high and were similar for those who developed HFpEF or HFrEF. Randomization to the intensive arm did not alter the risks for subsequent all-cause, or HF events in either HFpEF or HFrEF. Among those who developed HFpEF, age and Black race were independent predictors of clinical outcomes. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT01206062.
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