SBP, PP levels predict risk of heart failure

Both systolic blood pressure (SBP) and pulse pressure (PP) show a J-shaped association with cardiovascular risk among patients with heart failure (HF), suggests a study. The lowest risk is seen at SBP levels between 120 and 130 mm Hg and PP values between 50 and 60 mm Hg.

A team of investigators performed a pooled participant-level analysis of four trials (ie, I-PRESERVE, TOPCAT, PARAGON-HF, and DELIVERY) that examined irbesartan, spironolactone, sacubitril/valsartan, and dapagliflozin against either a placebo or an active comparator in patients with HF and a left ventricular ejection fraction ≥40 percent or ≥45 percent.

Restricted cubic splines were used to explore the association between continuous baseline SBP and PP and the primary endpoint of first HF hospitalization or cardiovascular death. In addition, the investigators assessed the impact of SBP categories (ie, <120, 120–129, 130–139, and ≥140 mm Hg) and PP quartiles on the primary endpoint.

Overall, 16,590 patients (mean age 71 years, 49 percent male, mean SBP 131 mm Hg, mean PP 55 mm Hg) were included in the analysis.

A J-shaped association was noted between SBP and the primary endpoint, with the lowest risk observed at 120 to 130 mm Hg. Likewise, PP showed a similar pattern, with the lowest risk at 50 to 60 mm Hg.

On the other hand, the highest SBP category (reference: 120–129 mm Hg) and PP quartile (reference: 46–54 mm Hg) correlated with an increased risk of HF (SBP: hazard ratio [HR], 1.22, 95 percent confidence interval [CI], 1.10–1.34; PP: HR, 1.22, 95 percent CI, 1.11–1.34).

Of note, higher PP correlated with a higher cardiovascular risk, irrespective of SBP levels.

“Hypertension is common in patients with HF with mildly reduced or preserved ejection fraction, and current guidelines recommend treating SBP to a target <130 mm Hg,” the investigators said. “PP, a marker of aortic stiffness, has been associated with increased risk of cardiovascular events.”