Abstract
BackgroundSystolic blood pressure (SBP) is a major determinant of PP. An SBP <120 mmHg is associated with a higher risk of mortality in HFpEF (AHA2016 Abstract 20566). We examined the association of PP with outcomes in patients with HFpEF stratified by SBP of 120 mmHg.MethodsOf the 8462 hospitalized patients with HF and EF ≥50% in the Medicare-linked OPTIMIZE-HF registry, 2859 had SBP <120 mmHg (discharge PPmedian 48; 1551 had PP <50 and 1308 had PP 50-100 mmHg). Propensity scores for PP <50 mmHg, estimated for each of the 2859 patients, were used to assemble a cohort of 1058 pairs of patients with PP <50 vs 50-100 mmHg, balanced on 57 baseline characteristics. We repeated the above process in the subset of 5603 patients with SBP ≥120 mmHg (PP median 70 mmHg) and in all 8462 patients (PP median 70 mmHg) assembling matched cohorts of 4402 (PP cutoff 70) and 6218 (PP cutoff 60), respectively.ResultsAmong the 2116 matched patients with SBP <120 mmHg, 1-year all-cause mortality occurred in 35% and 33% of patients with PP <50 vs 50-100 mmHg, resp. (HR, 1.09; 95% CI, 0.94-1.26; Figure). There was no association with all-cause or HF readmission. HRs (95% CIs) for 1-year mortality in the matched cohorts of SBP ≥120 mmHg (n=4402) and overall (n=6218) were 1.08 (0.96-1.21; p=0185; Figure) and 1.21 (1.10-1.32; p<0.001), respectively.ConclusionIn hospitalized patients with HFpEF, a lower PP is associated with worse outcomes, but not when stratified by SBP, suggesting that PP has no association with outcomes independent of SBP.