Abstract 166: Blood Pressure Variability and Cardiovascular Outcomes in Heart Failure with Preserved Ejection Fraction

Abstract

Background: High blood pressure variability (BPV), independent of mean blood pressure, is associated with increased cardiovascular events in patients with hypertension or chronic kidney disease. Heart failure with preserved ejection fraction (HFpEF) is often managed with aggressive blood pressure control, but the association of BPV with cardiovascular outcomes among patients with HFpEF has not been examined. Methods: We performed a post hoc analysis of the Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist (TOPCAT) trial. BPV was assessed for each patient as the standard deviation of all available systolic blood pressure measurements (SD-SBP) during follow up. A cox regression analysis, adjusting for demographic, clinical, and blood pressure medication and measurement characteristics (Figure), was performed to assess the independent association of BPV with all-cause death and a composite of cardiovascular death and heart failure hospitalization. BPV was modeled with a spline function with the median SD-SBP (9.95) chosen as reference, and as quartiles with the highest quartile (Q4) as reference Results: Among 3445 participants at baseline, mean age was 68.6, BMI was 32.1 and 51.5% were female. Over a median follow up of 3.4 years, average SD-SBP was 10.9 mmHg. BPV was associated with the risk of all-cause death [Hazard Ratio (95% CI) vs. Q4: Q1=0.85 (0.65, 1.2) p=0.2, Q2 = 0.75 (0.58, 0.96) p =0.03, Q3 = 0.74 (0.58, 0.93) p=0.01] and composite outcome of cardiovascular death or heart failure hospitalization [Q1 = 0.49 (0.39, 0.63) p < 0.01, Q2 = 0.63 (0.51, 0.77) p<0.01, Q3=0.69 (0.57, 0.83) p<0.01]. The risk of death and the composite outcome appeared to significantly increase as the SD-SBP increased above ~11 mmHg (Figure). Conclusion: In patients with HFpEF, the risk of all cause death and a composite of cardiovascular death and heart failure hospitalization significantly increased, as the SD-SBP increased beyond 11 mmHg. This association was independent of mean SBP. Whether reducing BPV is a potential therapeutic target in HFpEF requires further study.