Blood Pressure Control in a Diverse Population of Hypertensive Patients With Heart Failure

Abstract

Hypertensive patients with heart failure (HF), with reduced or preserved ejection fraction, belong to a vulnerable subset with high mortality risks. In HF patients, the current clinical guideline recommends attaining a systolic blood pressure (BP) <130mm Hg. However, levels of BP control and their correlates in this subgroup are not well understood. Our study aimed at establishing levels of BP control and its associated factors in a geographically, racially diverse population of hypertensive patients with HF. Our study involved 10,802 patients within a large health system in the Charlotte metropolitan area in 2019. We documented a high prevalence of systolic BP ≥130mm Hg, 48.1% (95% confidence interval 47.4% to 48.8%), and of BP ≥130/80mm Hg, 57.6% (57.0% to 58.3%). From a multivariate logistic regression model, systolic BP ≥130mm Hg was associated with race-ethnicity (p <0.0001), gender (p=0.0001), insurance (p <0.0001), attribution with a primary care physician (p=0.0001). Non-Hispanic Blacks (vs non-Hispanic Whites odds ratio [OR] 1.38, 1.28 to 1.48), women (OR 1.12, 1.06 to 1.19), and uninsured patients (vs privately insured OR 1.43, 1.20 to 1.72) had a higher risk of systolic BP ≥130mm Hg; patients with primary care physician attribution had a lower risk of systolic BP ≥130mm Hg (OR 0.87, 0.81 to 0.94). Similar results were found with the outcome BP ≥130/80mm Hg. Overall, further efforts are needed to optimize treatment in hypertensive patients with HF and improve health equity across patient communities.