Systolic blood pressure visit-to-visit variability and clinical outcomes of heart failure with preserved ejection fraction

Abstract

Abstract Background Previous studies have shown that increased systolic blood pressure visit-to-visit variability (SBP-VVV) is associated with higher risk for cardiovascular events in patients with hypertension, atrial fibrillation, and heart failure with reduced ejection fraction, However, no studies have reported the relationship between SBP-VVV and adverse outcomes in heart failure with preserved ejection fraction (HFpEF). Methods This was a post-hoc analysis of the TOPCAT trial, a multicentered, randomized, placebo-controlled trial of spironolactone in patients with HFpEF. SBP-VVV was assessed during the first year of the trial and clinical outcomes were analysed from the end of the first year to the end of the follow-up period. SBP-VVV was primarily assessed by SBP-SD, the standard deviation (SD) of the mean SBP across these six visits of every patient. The primary study outcome was the composite outcomes of cardiovascular death, hospitalization for heart failure or aborted cardiac arrest occurring after the first 12 months after randomization. The secondary outcomes included cardiovascular mortality, first HF hospitalization event, and all-cause mortality occurring beyond the first 12 months following randomization. Results Of the 2907 patients from the TOPACT trial, SBP-VVV was categorized into quartiles (1st, <6.05; 2nd, 6.06–8.94; 3rd, 8.95–12.81; and 4th, ≥12.82 mmHg) and as a continuous variable. During the subsequent median follow-up of 2.48 years, 373 (12.8%) patients met the primary outcome. On multiple Cox regression, patients in the 4th quartile were at higher risk for a primary outcome (hazard ratio for 4th vs. 1st quartile, 1.79;, 95% CI, 1.28–2.49; P<0.001). Patients in the 4th quartile were also at higher risk of HF hospitalization (hazard ratio for 4th vs. 1st quartile, 2.49; 95% CI, 1.54–4.02; P<0.001) and all-cause mortality (hazard ratio for 4th vs. 1st quartile, 1.52; 95% CI, 1.08–2.15; P=0.017). SBP-SD as a continuous variable was also associated with an increased risk of all outcomes. Conclusions In patients with HFpEF, high SBP-VVV was associated with an increased risk of adverse outcomes, independent of baseline and on-treatment SBP. Funding Acknowledgement Type of funding sources: None. Relationship between SBP-SD and HR