Blood pressure visit‐to‐visit variability and outcomes in patients with heart failure with preserved ejection fraction
Abstract Aims Previous studies report that blood pressure (BP) variability is associated with increased risk of adverse outcomes in patients diagnosed with cardiovascular disease. However, studies have not fully explored this association in patients with heart failure with preserved ejection fractio...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2021-10-01
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| Series: | ESC Heart Failure |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/ehf2.13542 |
| _version_ | 1831761640217903104 |
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| author | Qi Zhang Bingyang Zhou Yu Ma Yuecheng Hu Ximing Li Hongliang Cong |
| author_facet | Qi Zhang Bingyang Zhou Yu Ma Yuecheng Hu Ximing Li Hongliang Cong |
| author_sort | Qi Zhang |
| collection | DOAJ |
| description | Abstract Aims Previous studies report that blood pressure (BP) variability is associated with increased risk of adverse outcomes in patients diagnosed with cardiovascular disease. However, studies have not fully explored this association in patients with heart failure with preserved ejection fraction (HFpEF). This study sought to explore the association between visit‐to‐visit variability (VVV) of BP and clinical outcomes in patients with HFpEF. Methods and results A total of 1988 patients (mean age of 67.73 ± 9.22, 51.7% female) from the Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist (TOPCAT) trial were included in this study. BP‐VVV was determined by standard deviation (SD) of mean systolic BP (SBP‐SD) from six measurements (baseline and months 1, 2, 4, 8, and 12) during the first 12 months after randomization. Mean on‐treatment SBP during the first 12 months was 127.77 ± 10.42 mmHg, and the median of SBP‐SD was 8.15 mmHg. A total of 192 (9.7%) patients met the primary outcome during the subsequent median follow‐up of 35.16 months, including a composite of cardiovascular death, heart failure hospitalization, or aborted cardiac arrest. Multiple Cox regression analysis showed that SBP‐SD was independently associated with the increased risk of the primary outcome after adjusting for age, gender, method of BP measurement, treatment, renal function and common co‐morbidities, and the mean SBP during the first 12 months [hazard ratio (HR) for fourth vs. first quartile, 1.63; 95% confidence interval (CI), 1.07–2.49; P = 0.024]. Analysis showed that SBP‐SD as continuous variable was associated with a 23% increase in the risk of primary outcome (HR 1.23, 95% CI 1.06–1.43; P = 0.006). Conclusions The findings of the current study show that high SBP‐VVV in patients with HFpEF is associated with an increased risk of adverse outcomes independent of the mean on‐treatment SBP. |
| first_indexed | 2024-12-22T04:52:12Z |
| format | Article |
| id | doaj.art-2963026be29742829428e71577294bad |
| institution | Directory Open Access Journal |
| issn | 2055-5822 |
| language | English |
| last_indexed | 2024-12-22T04:52:12Z |
| publishDate | 2021-10-01 |
| publisher | Wiley |
| record_format | Article |
| series | ESC Heart Failure |
| spelling | doaj.art-2963026be29742829428e71577294bad2022-12-21T18:38:27ZengWileyESC Heart Failure2055-58222021-10-01853984399610.1002/ehf2.13542Blood pressure visit‐to‐visit variability and outcomes in patients with heart failure with preserved ejection fractionQi Zhang0Bingyang Zhou1Yu Ma2Yuecheng Hu3Ximing Li4Hongliang Cong5Department of Cardiology Tianjin Chest Hospital #261 Taierzhuangnan Road, Jinnan District Tianjin ChinaDepartment of Cardiology Tianjin Chest Hospital #261 Taierzhuangnan Road, Jinnan District Tianjin ChinaDepartment of Cardiology Tianjin Chest Hospital #261 Taierzhuangnan Road, Jinnan District Tianjin ChinaDepartment of Cardiology Tianjin Chest Hospital #261 Taierzhuangnan Road, Jinnan District Tianjin ChinaDepartment of Cardiology Tianjin Chest Hospital #261 Taierzhuangnan Road, Jinnan District Tianjin ChinaDepartment of Cardiology Tianjin Chest Hospital #261 Taierzhuangnan Road, Jinnan District Tianjin ChinaAbstract Aims Previous studies report that blood pressure (BP) variability is associated with increased risk of adverse outcomes in patients diagnosed with cardiovascular disease. However, studies have not fully explored this association in patients with heart failure with preserved ejection fraction (HFpEF). This study sought to explore the association between visit‐to‐visit variability (VVV) of BP and clinical outcomes in patients with HFpEF. Methods and results A total of 1988 patients (mean age of 67.73 ± 9.22, 51.7% female) from the Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist (TOPCAT) trial were included in this study. BP‐VVV was determined by standard deviation (SD) of mean systolic BP (SBP‐SD) from six measurements (baseline and months 1, 2, 4, 8, and 12) during the first 12 months after randomization. Mean on‐treatment SBP during the first 12 months was 127.77 ± 10.42 mmHg, and the median of SBP‐SD was 8.15 mmHg. A total of 192 (9.7%) patients met the primary outcome during the subsequent median follow‐up of 35.16 months, including a composite of cardiovascular death, heart failure hospitalization, or aborted cardiac arrest. Multiple Cox regression analysis showed that SBP‐SD was independently associated with the increased risk of the primary outcome after adjusting for age, gender, method of BP measurement, treatment, renal function and common co‐morbidities, and the mean SBP during the first 12 months [hazard ratio (HR) for fourth vs. first quartile, 1.63; 95% confidence interval (CI), 1.07–2.49; P = 0.024]. Analysis showed that SBP‐SD as continuous variable was associated with a 23% increase in the risk of primary outcome (HR 1.23, 95% CI 1.06–1.43; P = 0.006). Conclusions The findings of the current study show that high SBP‐VVV in patients with HFpEF is associated with an increased risk of adverse outcomes independent of the mean on‐treatment SBP.https://doi.org/10.1002/ehf2.13542TOPCAT trialHeart failure with preserved ejection fractionBlood pressure visit‐to‐visit variabilityOutcome research |
| spellingShingle | Qi Zhang Bingyang Zhou Yu Ma Yuecheng Hu Ximing Li Hongliang Cong Blood pressure visit‐to‐visit variability and outcomes in patients with heart failure with preserved ejection fraction ESC Heart Failure TOPCAT trial Heart failure with preserved ejection fraction Blood pressure visit‐to‐visit variability Outcome research |
| title | Blood pressure visit‐to‐visit variability and outcomes in patients with heart failure with preserved ejection fraction |
| title_full | Blood pressure visit‐to‐visit variability and outcomes in patients with heart failure with preserved ejection fraction |
| title_fullStr | Blood pressure visit‐to‐visit variability and outcomes in patients with heart failure with preserved ejection fraction |
| title_full_unstemmed | Blood pressure visit‐to‐visit variability and outcomes in patients with heart failure with preserved ejection fraction |
| title_short | Blood pressure visit‐to‐visit variability and outcomes in patients with heart failure with preserved ejection fraction |
| title_sort | blood pressure visit to visit variability and outcomes in patients with heart failure with preserved ejection fraction |
| topic | TOPCAT trial Heart failure with preserved ejection fraction Blood pressure visit‐to‐visit variability Outcome research |
| url | https://doi.org/10.1002/ehf2.13542 |
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