Diastolic hypotensive episodes predict MACE, rehospitalization in stable HF patients

In patients with stable heart failure (HF), a diastolic hypotension episode (diastolic blood pressure [DBP] <60 mm Hg) is associated with hemodynamic vulnerability and with a higher risk of adverse outcomes, particularly HF rehospitalization, a study has shown. 

“Optimal BP management is important for improving clinical outcomes for patients with HF,” the researchers said. “While systolic [S]BP has traditionally guided therapy, the prognostic value of transient diastolic hypotension in chronic HF is unclear.” 

This multicentre retrospective cohort study was conducted to address such a gap. Data were obtained from the electronic health records of three tertiary university hospitals in South Korea (January 2017 to June 2024). 

The research team included a total of 2,477 patients hospitalized for acute HF decompensation and stabilized thereafter. They also obtained BP measurements 3 to 12 times during a 1-year follow-up. 

One year after discharge, the researchers tracked major adverse cardiovascular events (MACE), defined as cardiovascular death, new myocardial infarction, stroke, or HF rehospitalization. 

Patients with one or more recordings of DBP <60 mm Hg showed higher MACE rates (35.0 percent vs 26.9 percent; p<0.01) and increased HF rehospitalization (24.4 percent vs 15.2 percent; p<0.01). 

Multivariate analyses revealed that a DBP <60 mm Hg episode was borderline associated with MACE (HR, 1.18; p=0.07) and independently predictive of HF rehospitalization (HR, 1.39; p<0.01). 

“Monitoring SBP and diastolic parameters is important for optimizing HF management strategies,’ the researchers said.