NYMC Faculty Publications

Initiation of Anti-Hypertensive Drugs and Outcomes in Patients With Heart Failure With Reduced Ejection Fraction

Phillip H. Lam, Veterans Affairs Medical Center, Washington, DC; Georgetown University, Washington, DC; MedStar Washington Hospital Center, Washington, DC. Electronic address: lp30884@gmail.com.
Wilbert S. Aronow, Westchester Medical Center and New York Medical College, Valhalla, NY.
Apostolos Tsimploulis, Veterans Affairs Medical Center, Washington, DC; Georgetown University, Washington, DC; MedStar Washington Hospital Center, Washington, DC.
Poonam Bhyan, Cape Fear Valley Medical Center, Fayetteville, NC.
Shalini D. Allam, Veterans Affairs Medical Center, Washington, DC; Georgetown University, Washington, DC.
Samir Patel, Veterans Affairs Medical Center, Washington, DC; George Washington University, Washington, DC.
Venkatesh K. Raman, Veterans Affairs Medical Center, Washington, DC; Georgetown University, Washington, DC.
Cherinne Arundel, Veterans Affairs Medical Center, Washington, DC; Georgetown University, Washington, DC; George Washington University, Washington, DC.
Farooq H. Sheikh, Georgetown University, Washington, DC; MedStar Washington Hospital Center, Washington, DC.
Ioannis E. Kanonidis, Aristotle University, Thessaloniki, Greece.
Prakash Deedwania, University of California, San Francisco.
Richard M. Allman, George Washington University, Washington, DC.
Gregg C. Fonarow, University of California, Los Angeles.
Charles Faselis, Veterans Affairs Medical Center, Washington, DC; George Washington University, Washington, DC.
Ali Ahmed, Veterans Affairs Medical Center, Washington, DC; Georgetown University, Washington, DC; George Washington University, Washington, DC. Electronic address: ali.ahmed@va.gov.

Author Type(s)

Faculty

Journal Title

The American Journal of Medicine

First Page

737

Last Page

744

Document Type

Article

Publication Date

6-1-2022

Department

Medicine

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.

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