Reverse J-Curve Relationship Between On-Treatment Blood Pressure and Mortality in Patients With Heart Failure

Lee, Sang Eun; Lee, Hae Young; Cho, Hyun Jai; Choe, Won Seok; Kim, Hokon; Choi, Jin Oh; Jeon, Eun Seok; Kim, Min Seok; Hwang, Kyung Kuk; Chae, Shung Chull; Baek, Sang Hong; Kang, Seok Min; Choi, Dong Ju; Yoo, Byung Su; Kim, Kye Hun; Cho, Myeong Chan; Kim, Jae Joong; Oh, Byung Hee

doi:10.1016/j.jchf.2017.08.015

Cited by 68 publications

(73 citation statements)

References 39 publications

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“…Similar to our findings, other observational analyses have indicated that an optimum SBP target might be ~120–130 mmHg in the HF population (i.e. secondary to any cause) . Our findings extend our knowledge by examining this association in those with documented CAD and hypertension.…”

Section: Discussionsupporting

confidence: 91%

Systolic blood pressure, heart rate, and outcomes in patients with coronary disease and heart failure

et al. 2019

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Aims Data regarding the optimal systolic blood pressure (SBP) and heart rate (HR) for coronary artery disease (CAD) patients with hypertension and a history of heart failure (HF) are limited. Accordingly, using data from a large clinical trial, we investigated the association between SBP and heart rate and subsequent adverse outcomes in CAD patients with a history of HF, and we aimed to better understand how pre‐existing HF impacts outcomes among patients with CAD. Methods and results Among 22 576 CAD patients enrolled in the INternational VErapamil SR‐Trandolapril STudy (INVEST), 1256 were identified with a history of physician‐diagnosed HF New York Heart Association (NYHA) Class 1–3 at entry. The primary outcome was the first occurrence of all‐cause death, myocardial infarction (MI), or stroke. Cox proportional‐hazards models adjusted for pre‐specified covariates were constructed to estimate risk among the HF cohort compared with a case‐matched sample from the non‐HF cohort. At a mean 2.5 years' follow‐up, those with prior HF had a higher risk of the primary outcome (hazard ratio (HR) 2.55, 95% confidence interval 2.30–2.83, P < 0.0001). Among those with history of HF, a low (<120 mmHg) or high (>140 mmHg) SBP and heart rate ≥ 85 b.p.m. were associated with increased risk for adverse outcomes, which persisted after covariate adjustment. Conclusions In patients with CAD, a physician diagnosis of HF at baseline portended a higher risk for death, MI, or stroke than in those without an HF history. Achieving SBP of 120–140 mmHg and heart rate < 85 b.p.m. was associated with a better outcome in patients with known HF and CAD.

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Section: Discussionsupporting

confidence: 91%

Systolic blood pressure, heart rate, and outcomes in patients with coronary disease and heart failure

et al. 2019

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“…Categorical variables are given as numbers and percentages and were compared using the chi-squared test. Blood pressures (BP) were measured at each predefined follow-up visit, and on-treatment BPs were calculated by averaging measurements before the occurrence of an event or end of follow-up [14]. Restricted cubic splines and nonlinear Cox proportional hazard regression models were used to assess the association between BP and outcomes.…”

Section: Statistical Analysesmentioning

confidence: 99%

Management and Prognosis of Heart Failure in Octogenarians: Final Report from the KorAHF Registry

Cho

Lee

et al. 2020

JCM

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Treatment of heart failure (HF) in the elderly face many difficulties due to lack of robust evidence. We analyzed the outcome of HF in octogenarians using a nationwide HF registry. Among 5625 patients from the Korean Acute Heart Failure (KorAHF) registry, prognosis of octogenarian HF and the association of guideline-directed medical therapy (GDMT) with mortality and readmissions were analyzed. Octogenarian patients (1185, 22.4%) showed a higher mortality, and males were especially at increased risk (HR (hazard ratio) 1.19, 95% CI 1.01–1.40). A J-curve association between blood pressure (BP) and mortality was observed regardless of age, but the nadir value was lower in octogenarians (123.8 vs. 127.9 mmHg for systolic blood pressure (SBP); 67.1 vs. 73.9 mmHg for diastolic blood pressure (DBP), p < 0.001). Use of GDMT in octogenarian patients with HF and reduced ejection fraction (EF) were inadequate (74.3%, 47.1%, and 46.1% in octogenarians vs. 78.4%, 59.8%, and 55.2% in non-elderly for renin-angiotensin system inhibitors, beta-blockers, and aldosterone antagonists, respectively; all p < 0.05). However, those on medications had a significant reduction in 6 month mortality. For octogenarians with HF and preserved EF, angiotensin receptor blocker use reduced hospitalizations for HF in men (HR 0.19, 95% CI 0.04–0.87), but not in women (p-interaction = 0.037). HF in octogenarians were found to have different characteristics compared with the non-elderly. However, adequate use of GDMT was still associated with improved survival, and more attention should be given to prescribing medications with clinical benefits.

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“…33 In addition, a recent study that used data form the Korean Acute Heart Failure (KorAHF) prospective registry demonstrated that BP <130/70 mmHg at hospital discharge and during follow-up was associated with worse survival in HF patients. 34 This suggests that it may be dangerous to lower DBP below 70 mmHg in patients with HF. In the analysis of data from the TOPCAT (Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist) trial, DBP values ≥90 and <60 mmHg were associated with a significant risk of adverse outcomes in patients with HF with preserved ejection fraction who were treated for HTN.…”

Section: Concerns Related To Dbpmentioning

confidence: 99%

Controversies in the 2017 ACC/AHA Hypertension Guidelines: Who Can Be Eligible for Treatments Under the New Guidelines?　― An Asian Perspective ―

Ihm

Bakris

Sakuma

et al. 2019

Circ J

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Until the 2017 ACC/AHA Hypertension Guidelines were released, the target blood pressure (BP) for adults with hypertension (HTN) was 140/90 mmHg in most of the guidelines. The new 2018 ESC/ESH, Canadian, Korean, Japan, and Latin American hypertension guidelines have maintained the <140/90 mmHg for the primary target in the general population and encourage reduction to <130/80 if higher risk. This is more in keeping with the 2018 American Diabetes Association guidelines. However, the 2017 ACC/AHA guidelines classify HTN as BP ≥130/80 mmHg and generally recommend target BP levels below 130/80 mmHg for hypertensive patients independently of comorbid disease or age. Although the new guidelines mean that more people (nearly 50% of adults) will be diagnosed with HTN, the cornerstone of therapy is still lifestyle management unless BP cannot be lowered to this level; thus, more people will require BP-lowering medications. To date, there have been many controversies about the definition of HTN and the target BP. Targeting an intensive systolic BP goal can increase the adverse effects of multiple medications and the cardiovascular disease risk by excessively lowering diastolic BP, especially in patients with high risk, including those with diabetes, chronic kidney disease, heart failure, and coronary artery disease, and the elderly. In this review, we discuss these issues, particularly regarding the optimal target BP.

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Reverse J-Curve Relationship Between On-Treatment Blood Pressure and Mortality in Patients With Heart Failure

Cited by 68 publications

References 39 publications

Systolic blood pressure, heart rate, and outcomes in patients with coronary disease and heart failure

Systolic blood pressure, heart rate, and outcomes in patients with coronary disease and heart failure

Management and Prognosis of Heart Failure in Octogenarians: Final Report from the KorAHF Registry

Controversies in the 2017 ACC/AHA Hypertension Guidelines: Who Can Be Eligible for Treatments Under the New Guidelines?　― An Asian Perspective ―

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Reverse J-Curve Relationship Between On-Treatment Blood Pressure and Mortality in Patients With Heart Failure

Cited by 68 publications

References 39 publications

Systolic blood pressure, heart rate, and outcomes in patients with coronary disease and heart failure

Systolic blood pressure, heart rate, and outcomes in patients with coronary disease and heart failure

Management and Prognosis of Heart Failure in Octogenarians: Final Report from the KorAHF Registry

Controversies in the 2017 ACC/AHA Hypertension Guidelines: Who Can Be Eligible for Treatments Under the New Guidelines? ― An Asian Perspective ―

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Controversies in the 2017 ACC/AHA Hypertension Guidelines: Who Can Be Eligible for Treatments Under the New Guidelines?　― An Asian Perspective ―