What is the optimal SBP range for survival in HFpEF patients?

Maintaining systolic blood pressure (SBP) level at 120–129 mm Hg in the long term (LT) leads to the highest reduction in risk of all-cause mortality and improvement of Kansas City Cardiomyopathy Questionnaire (KCCQ) score among patients with heart failure with preserved ejection fraction (HFpEF), suggests a recent study.

The investigators examined 3,310 participants from the Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist study with available different SBP measurements from different follow-ups. LT-SBP was defined as the mean SBP value from 4-week measurement to the last one. Adjusted Cox proportional hazards models and restricted cubic spline models were used to assess the association of LT-SBP and outcomes.

After multivariable adjustment, a lower mortality risk was found to be associated with LT-SBP of 120–129 mm Hg (hazard ratio [HR], 0.66, 95 percent confidence interval [CI], 0.51–0.87; p=0.003) and 130–139 mm Hg (HR, 0.68, 95 percent CI, 0.51–0.90; p=0.007). LT-SBP of 100–119 mm Hg showed a similar mortality risk (HR, 0.96, 95 percent CI, 0.72–1.28; p=0.778) relative to LT-SBP of at least 140 mm Hg.

A U-shaped relationship was noted between LT-SBP and all-cause mortality (p<0.001) with nadir risk occurring around 123 mm Hg. Similar associations were seen between LT-SBP and composite endpoint of heart failure readmission or all-cause mortality.

Beginning from the 12-month follow-up, a significantly higher adjusted mean improvement in KCCQ score was observed in the 120–129-mm Hg group than in the at least 140-mm Hg group, without significant differences in other groups.

“Future randomized clinical trials need to specifically evaluate optimal SBP treatment goals in patients with HFpEF,” the authors said.