Antihypertensive drug does not lower death risk in HFrEF patients

Use of an antihypertensive drug does not appear to reduce the risk of all-cause mortality or hospital readmission in hospitalized older patients with heart failure with reduced ejection fraction (HFrEF) who are receiving contemporary treatments for HF, reveals a recent study.

A total of 7,966 patients with HFrEF (ejection fraction ≤40 percent) without renal failure in the Medicare-linked OPTIMIZE-HF were not receiving antihypertensive medications prior to hospitalization. Of these, 692 received discharge prescriptions for thiazides and calcium channel blockers.

The researchers assembled a propensity score-matched cohort of 687 pairs of patients initiated and not initiated on antihypertensive drugs. Participants were balanced on 38 baseline characteristics. The researchers estimated hazard ratios (HRs) and 95 percent confidence intervals (CIs) for outcomes associated with antihypertensive drug initiation in the matched cohort.

Of the matched patients (n=1,374, mean age 74 years, 41 percent female, 17 percent African-American), 66 percent were discharged on renin-angiotensin system inhibitors and beta blockers and 10 percent on aldosterone antagonists.

Seventy percent of the patients died and 53 percent had HF readmission during 6 years of follow-up (median 2.5 years). Initiation of antihypertensive medication did not significantly correlate with all-cause mortality (HR, 0.95, 95 percent CI, 0.83‒1.07) or HF readmission (HR, 0.93, 95 percent CI, 0.80‒1.07). Such associations persisted during 30 days and 12 months of follow-up.

“In patients with HFrEF and hypertension, systolic blood pressure is recommended to be maintained below 130 mm Hg, although this has not been shown to be associated with improved outcomes,” the researchers said.