Intensive BP lowering reduces ED visit or hospitalization in HFpEF as well as HFrEF: Study

Intensive BP treatment is associated with reduced acute decompensated heart failure (ADHF) events in the SPRINT (Systolic Blood Pressure Intervention Trial).

A new study shows that in the SPRINT study, intensive blood pressure reduction reduced both acute decompensated preserved ejection fraction (HFpEF) and reduced EF (HFrEF) events. Following an initial incident ADHF, the rates of subsequent hospitalization and mortality were high, and they were comparable for those who developed HFpEF or HFrEF. In either HFpEF or HFrEF, randomization to the intensive arm had no effect on the risks of subsequent all-cause or heart failure events. Age and Black race were independent predictors of clinical outcomes among those who developed HFpEF.

This study was conducted by Bharathi Upadhya and team with the objective to report on the effect on HF with preserved ejection fraction (HFpEF) and HF with reduced ejection fraction (HFrEF) and their subsequent outcomes. The findings of this study were published in the Circulation: Heart Failure on 26th November, 2021.

The Incident ADHF was defined in this study as a hospitalization or emergency department visit that was confirmed and formally adjudicated by a blinded events committee using standardized protocols. HFpEF was defined as EF45 percent, while HFrEF was defined as EF45 percent.

The results were stated as follows:

Among the 133 participants with incident ADHF who underwent EF assessment, 69 (52%) had HFpEF and 64 (48%) had HFrEF (P value: 0.73).

During an average of 3.3 years of follow-up, rates of subsequent all-cause and HF hospital readmission and mortality were high in those who developed incident ADHF, but there were no significant differences between those who developed HFpEF versus HFrEF.

Regardless of EF subtype, randomization to the intensive arm had no effect on subsequent mortality or readmissions after the initial ADHF event.

Although the relatively small number of events limited statistical power, age was an independent predictor of all-cause mortality, and Black race was an independent predictor of all-cause and HF hospital readmission during follow-up among participants who developed HFpEF.

In conclusion, in patients with HF who had either a HFpEF or a HFrEF, intensive blood pressure lowering reduced the episodes of acute decompensated HF (ADHF). Given the scarcity of HFpEF treatments and the poor prognosis, treating hypertension to prevent HFpEF is critical.

Reference:

Upadhya, B., Willard, J. J., Lovato, L. C., Rocco, M. V., Lewis, C. E., Oparil, S., Cushman, W. C., Bates, J. T., Bello, N. A., Aurigemma, G., Johnson, K. C., Rodriguez, C. J., Raj, D. S., Rastogi, A., Tamariz, L., Wiggers, A., & Kitzman, D. W. (2021). Incidence and Outcomes of Acute Heart Failure With Preserved Versus Reduced Ejection Fraction in SPRINT. In Circulation: Heart Failure. Ovid Technologies (Wolters Kluwer Health). https://doi.org/10.1161/circheartfailure.121.008322