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Lam PH, Tsimploulis A, Patel S, Raman VK, Arundel C, Faselis C, Deedwania P, Sheikh FH, Banerjee SK, Allman RM, Fonarow GC, Aronow WS, Ahmed A. Initiation of anti-hypertensive drugs and outcomes in patients with heart failure with preserved ejection fraction and persistent hypertension. Prog Cardiovasc Dis 2022; 73:17-23. [PMID: 35777433 DOI: 10.1016/j.pcad.2022.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Accepted: 06/25/2022] [Indexed: 11/30/2022]
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.
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Affiliation(s)
- Phillip H Lam
- Veterans Affairs Medical Center, Washington, DC, USA; Georgetown University, Washington, DC, USA; MedStar Washington Hospital Center, Washington, DC, USA
| | - Apostolos Tsimploulis
- Veterans Affairs Medical Center, Washington, DC, USA; Georgetown University, Washington, DC, USA; MedStar Washington Hospital Center, Washington, DC, USA
| | - Samir Patel
- Veterans Affairs Medical Center, Washington, DC, USA; George Washington University, Washington, DC, USA
| | - Venkatesh K Raman
- Veterans Affairs Medical Center, Washington, DC, USA; Georgetown University, Washington, DC, USA
| | - Cherinne Arundel
- Veterans Affairs Medical Center, Washington, DC, USA; George Washington University, Washington, DC, USA; Uniformed Services University, Washington, DC, USA
| | - Charles Faselis
- Veterans Affairs Medical Center, Washington, DC, USA; George Washington University, Washington, DC, USA; Uniformed Services University, Washington, DC, USA
| | - Prakash Deedwania
- Veterans Affairs Medical Center, Washington, DC, USA; University of California, San Francisco, CA, USA
| | - Farooq H Sheikh
- Georgetown University, Washington, DC, USA; MedStar Washington Hospital Center, Washington, DC, USA
| | | | - Richard M Allman
- Uniformed Services University, Washington, DC, USA; University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Wilbert S Aronow
- Westchester Medical Center and New York Medical College, Valhalla, NY, USA
| | - Ali Ahmed
- Veterans Affairs Medical Center, Washington, DC, USA; Georgetown University, Washington, DC, USA; Uniformed Services University, Washington, DC, USA.
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