Abstract MP73: Systolic Blood Pressure Control among Hypertensives and Incident Heart Failure: The Atherosclerosis Risk in Communities Study

Abstract

Background: Studies document a progressive increase in heart disease risk as systolic blood pressure (SBP) rises above 115mmHg, suggesting a benefit of treatment to a SBP <120mmHg. Hypertension is a major risk factor for heart failure (HF) but whether an SBP <120mmHg lowers HF risk is unknown. Methods: Hypertensive participants at baseline (SBP/DBP >140/90mmHg, report of hypertension or taking BP medication) from ARIC, a prospective population-based study of black and white men and women from 4 US communities, were included. SBP measured at baseline and at three triennial visits was treated as a time-dependent variable and categorized as: Elevated (SBP >140), Standard (SBP 120-139) and Intensive (SBP <120). Prevalent HF at baseline was excluded. Incident HF was defined from HF hospitalization or a death certificate with an ICD-9 or ICD-10 codes. Multivariable Cox regression models included baseline age, sex, diabetes, BMI, high cholesterol, smoking and alcohol intake. Results: After median follow-up of 20.8 years, a total of 1,111 incident HF events occurred in 4,802 hypertensives. Participants with elevated SBP had less HF-free survival compared to those with intensive group (log-rank p<0.001). However, there was no difference in incident HF-free survival among those with standard vs. intensive group (log-rank p=0.08). In adjusted analysis, findings remained similar for elevated SBP (HR: 1.2; 95% CI 1.0-1.5, intensive group as referent); and for standard SBP (HR: 0.9; 95% CI 0.8-1.1, intensive group as referent). There were no differences by race and sex (p for interaction >0.05). Further adjustment for BP medication use at baseline did not significantly affect the results. Conclusion: Hypertension control is necessary to prevent HF. Our results suggest that among hypertensives, having elevated SBP carries the highest risk for HF but in this categorical analysis we observed no risk difference between the standard and intensive SBP groups.