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Prognostic Value of Time in Blood Pressure Target Range Among Patients With Heart Failure

Chen, K; Li, C; Cornelius, V; Yu, D; Wang, Q; Shi, R; Wu, Z; Su, H; Yan, J; Chen, T; Jiang, Z

Authors

K Chen

C Li

V Cornelius

Q Wang

R Shi

Z Wu

H Su

J Yan

T Chen

Z Jiang



Abstract

BACKGROUND Blood pressure (BP) is a continuous and dynamic measure. However, standard BP control metrics may not reflect the variability in BP over time. OBJECTIVES This study assessed the prognostic value of time in BP target range among hypertensive patients with heart failure (HF). METHODS The authors performed a post hoc analysis of data from the TOPCAT (Treatment of Preserved Cardiac Function HF with an Aldosterone Antagonist) trial and the BEST (Beta-Blocker Evaluation of Survival Trial). Time in target range (TTR) for each patient was calculated using linear interpolation across the study period with the target range of systolic BP between 120 and 130 mm Hg. RESULTS A total of 4,789 hypertensive patients (n =1,654 from BEST and n = 3,135 from TOPCAT) were included. The cumulative incidences of primary endpoint (ie, cardiovascular death or HF hospitalization) were highest among the top quartile of TTR with a dose-dependent manner across quartiles (P-trend < 0.005). The top quartile of TTR was significantly associated with a lower risk of primary outcome using adjusted Cox regression model (HR: 0.71; 95% CI: 0.60-0.82), cardiovascular mortality (HR: 0.68; 95% CI: 0.55-0.84), HF hospitalization (HR: 0.70; 95% CI: 0.58-0.85), all-cause mortality (HR: 0.69; 95% CI: 0.58-0.83), and any hospitalization (HR: 0.76; 95% CI: 0.67-0.85). Further analyses using restricted cubic spline indicated a linear relationship between TTR and primary outcome. Similar patterns were observed in the individual trial. Sensitivity analyses generated consistent results while redefining target range as 110 to 130 mm Hg for systolic BP or 70 to 80 mm Hg for diastolic BP. CONCLUSIONS TTR could independently predict major adverse cardiovascular events in hypertensive patients with HF. (C) 2022 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation.

Journal Article Type Article
Acceptance Date Jan 13, 2022
Online Publication Date Apr 6, 2022
Publication Date 2022-06
Journal JACC: Heart Failure
Print ISSN 2213-1779
Publisher Elsevier
Peer Reviewed Peer Reviewed
Volume 10
Issue 6
Pages 369-379
DOI https://doi.org/10.1016/j.jchf.2022.01.010
Keywords hypertension, heart failure, time in target range, quality of care, cardiovascular event
Publisher URL https://www.jacc.org/doi/full/10.1016/j.jchf.2022.01.010