Systolic Blood Pressure and Outcomes in Older Patients with HFpEF and Hypertension.

BACKGROUND New hypertension and heart failure guidelines recommend that systolic blood pressure (SBP) in patients with heart failure with preserved ejection fraction (HFpEF) and hypertension be lowered to <130 mmHg. METHODS Of the 6778 hospitalized patients with HFpEF and a history of hypertension in the Medicare-linked OPTIMIZE-HF registry, 3111 had a discharge SBP <130 mmHg. Using propensity scores for SBP <130 mmHg, we assembled a matched cohort of 1979 pairs with SBP <130 versus ≥130 mmHg, balanced on 66 baseline characteristics (mean age, 79 years; 69% women; 12% African American). We then assembled a second matched cohort of 1326 pairs with SBP <120 versus ≥130 mmHg. Hazard ratios (HRs) and 95% confidence intervals (CIs) for outcomes associated with SBP <130 and <120 mmHg were separately estimated in the matched cohort using SBP ≥130 mmHg as the reference. RESULTS HRs (95% CIs) for 30-day, 12-month, and 6-year all-cause mortality associated with SBP <130 mmHg were 1.20 (0.91-1.59; p=0.200), 1.11 (0.99-1.26; p=0.080), and 1.05 (0.98-1.14; p=0.186), respectively. Respective HRs (95% CIs) associated with SBP <120 mmHg were 1.68 (1.21-2.34; p=0.002), 1.28 (1.11-1.48; p=0.001), and 1.11 (1.02-1.22; p=0.022). There was no association with readmission. CONCLUSIONS Among older patients with HFpEF and hypertension, compared with SBP ≥130 mmHg, the new target SBP <130 mmHg had no association with outcomes, but SBP <120 mmHg was associated with a higher risk of death but not of readmission. Future prospective studies need to evaluate optimal SBP treatment goals in these patients.