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Systolic BP and Outcomes in Patients with HFpEF

JAMA Cardiol; ePub 2018 Feb 14; Tsimploulis, et al

A systolic blood pressure (SBP) level <120 mm Hg among hospitalized patients with heart failure with preserved ejection fraction (HFpEF) is significantly associated with greater risk of short- and long-term mortality, a recent study found. The propensity-matched observational study included 25,354 patients who were discharged alive; 8,873 (35.0%) had an ejection fraction of at least 50%, and of these, 3,915 (44.1%) had stable SPB levels. A total of 1,076 of 3,915 (27.5%) had SBP levels <120 mm Hg, of whom 901 (83.7%) were matched by propensity scores with 901 patients with SBP levels of ≥120 mm Hg who were balanced on 58 baseline characteristics. Researchers found:

  • 30-day all-cause mortality occurred in 91 (10%) and 45 (5%) of matched patients with discharge of SBP of <120 mm Hg vs ≥120 mm Hg, respectively (HR, 2.07).
  • SBP level <120 mm Hg was also associated with a higher risk of mortality at 1 year and during a median follow-up of 2.1 (overall 6) years (HR, 1.17).
  • SBP levels <120 mm Hg was associated with a higher risk of heart failure readmission at 30 days, but not at 1 or 6 years.


Tsimploulis A, Lam PH, Arundel C, et al. Systolic blood pressure and outcomes in patients with heart failure with preserved ejection fraction. [Published online ahead of print February 14, 2018]. JAMA Cardiol. doi:10.1001/jamacardio.2017.5365.


This is an important paper since the American Heart Association’s Hypertension guidelines define normal blood pressure as <120 mmHg with a target blood pressure of <130 mmHg.1 While these targets are supported by the SPRINT study, which showed decreased cardiovascular endpoints in patients with pre-existing coronary disease or those with a calculated 10-year risk of cardiovascular disease of >15%, it is not clear that the improved outcome applies to all other groups as well, included those with low cardiovascular risk or those with existent heart failure.2 This study raises a question as to the correct target blood pressure in patients with HFpEF, a common high risk group, and suggests that a BP >120 mmHg, and maybe even >130 mmHg, may lead to better outcomes. —Neil Skolnik, MD

  1. Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. [Published online ahead of print November 13, 2017]. Hypertension. doi:10.1161/HYP.0000000000000066.
  2. Williamson JD, Supiano MA, Applegate WB, et al; SPRINT Research Group. Intensive vs standard blood pressure control and cardiovascular disease outcomes in adults aged 75 years: A randomized clinical trial. JAMA. 2016;315(24):2673-2682.

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