Abstract
Background
In patients with heart failure with reduced ejection fraction (HFrEF) and hypertension,
systolic blood pressure is recommended to be maintained below 130 mmHg, although this
has not been shown to be associated with improved outcomes. We examined the association
between anti-hypertensive drug initiation and outcomes in patients with HFrEF.
Methods
In the Medicare-linked OPTIMIZE-HF, 7966 patients with HFrEF (ejection fraction ≤40%)
without renal failure were not receiving anti-hypertensive drugs before hospitalization,
of whom 692 received discharge prescriptions for those drugs (thiazides and calcium
channel blockers). We assembled a propensity score-matched cohort of 687 pairs of
patients initiated and not initiated on anti-hypertensive drugs, balanced on 38 baseline
characteristics. Hazard ratios (HR) and 95% confidence intervals (CIs) for outcomes
associated with anti-hypertensive drug initiation were estimated in the matched cohort.
Results
Matched patients (n = 1374) had a mean age of 74 years, 41% were female, 17% were
African-American, 66% were discharged on renin-angiotensin system inhibitors and beta
blockers, and 10% on aldosterone antagonists. During 6 (median 2.5) years of follow-up,
70% of the patients died and 53% had heart failure readmission. Anti-hypertensive
drug initiation was not significantly associated with all-cause mortality (HR, 0.95;
95% CI, 0.83-1.07) or heart failure readmission (HR, 0.93; 95% CI, 0.80-1.07). Similar
associations were observed during 30 days and 12 months of follow-up.
Conclusions
Among hospitalized older patients with HFrEF receiving contemporary treatments for
heart failure, initiation of an anti-hypertensive drug was not associated with a lower
risk of all-cause mortality or hospital readmission.
Keywords
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References
- Isolated systolic hypertension and incident heart failure in older adults: a propensity-matched study.Hypertension. 2009; 53: 458-465
- Prevention of heart failure by antihypertensive drug treatment in older persons with isolated systolic hypertension. SHEP Cooperative Research Group.JAMA. 1997; 278: 212-216
- 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines.J Am Coll Cardiol. 2013; 62: e147-e239
- Systolic blood pressure and outcomes in patients with heart failure with reduced ejection fraction.J Am Coll Cardiol. 2019; 73: 3054-3063
- Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure (OPTIMIZE-HF): rationale and design.Am Heart J. 2004; 148: 43-51
- Characteristics, treatments, and outcomes of patients with preserved systolic function hospitalized for heart failure: a report from the OPTIMIZE-HF Registry.J Am Coll Cardiol. 2007; 50: 768-777
- Combination of isosorbide dinitrate and hydralazine in blacks with heart failure.N Engl J Med. 2004; 351: 2049-2057
- Bias in observational studies of prevalent users: lessons for comparative effectiveness research from a meta-analysis of statins.Am J Epidemiol. 2012; 175: 250-262
- The central role of propensity score in observational studies for causal effects.Biometrika. 1983; 70: 41-55
- Using propensity score to help design observational studies: application to the tobacco litigation.Health Serv Outcomes Res Methodol. 2001; 2: 169-188
- Digoxin initiation and outcomes in patients with heart failure with preserved ejection fraction.Am J Med. 2020; 133: 1187-1194
- Prior heart failure hospitalization and outcomes in patients with heart failure with preserved and reduced ejection fraction.Am J Med. 2020; 133: 84-94
- Digoxin initiation and outcomes in patients with heart failure (HFrEF and HFpEF) and atrial fibrillation.Am J Med. 2020; 133: 1460-1470
- Loop diuretic prescription and long-term outcomes in heart failure: association modification by congestion.Am J Med. 2021; 134: 797-804
- Systolic blood pressure and outcomes in older patients with HFpEF and hypertension.Am J Med. 2021; 134: e252-e263
- Design and rationale of studies of neurohormonal blockade and outcomes in diastolic heart failure using OPTIMIZE-HF registry linked to Medicare data.Int J Cardiol. 2013; 166: 230-235
- Effect of amlodipine on morbidity and mortality in severe chronic heart failure. Prospective Randomized Amlodipine Survival Evaluation Study Group.N Engl J Med. 1996; 335: 1107-1114
- Effect of amlodipine on the survival of patients with severe chronic heart failure due to a nonischemic cardiomyopathy: results of the PRAISE-2 study (prospective randomized amlodipine survival evaluation 2).JACC Heart Fail. 2013; 1: 308-314
- Clinical profile and prognostic value of low systolic blood pressure in patients hospitalized for heart failure with reduced ejection fraction: insights from the Efficacy of Vasopressin Antagonism in Heart Failure: Outcome Study with Tolvaptan (EVEREST) trial.Am Heart J. 2013; 165: 216-225
- 2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America.J Am Coll Cardiol. 2017; 70: 776-803
- Association between mean systolic and diastolic blood pressure throughout the follow-up and cardiovascular events in acute myocardial infarction patients with systolic dysfunction and/or heart failure: an analysis from the High-Risk Myocardial Infarction Database Initiative.Eur J Heart Fail. 2018; 20: 323-331
- A smoker's paradox in patients hospitalized for heart failure: findings from OPTIMIZE-HF.Eur Heart J. 2008; 29: 1983-1991
- Complex interaction of obesity, intentional weight loss and heart failure: a systematic review and meta-analysis.Heart. 2020; 106: 58-68
- Digoxin-mortality: randomized vs. observational comparison in the DIG trial.Eur Heart J. 2019; 40: 3336-3341
- The prevalent-user bias in observational studies and the importance of new-user design [Letter to the editor].Eur Heart J. 2019; (Available at:) (Accessed January 10, 2021)
Article Info
Publication History
Published online: November 29, 2021
Footnotes
Funding: AA was in part supported by the National Institutes of Health through grants (R01-HL085561, R01-HL085561-S and R01-HL097047) from the National Heart, Lung, and Blood Institute and by the Department of Veterans Affairs Office of Research and Development through grant (I01HX002422) from the Health Services Research & Development Service. OPTIMIZE-HF was sponsored by GlaxoSmithKline, but played no role in the design, conduct, analyses or interpretation of the current study.
Conflict of Interest: GCF reports consulting with Abbott, Amgen, Bayer, Janssen, Medtronic, and Novartis, and was the Principal Investigator of OPTIMIZE-HF. None of the other authors report any conflicts of interest related to this manuscript.
The content is solely the responsibility of the authors and does not necessarily represent the official views of the Department of Veterans Affairs.
Authorship: All authors had access to the data and a role in writing this manuscript.
Identification
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