NYMC Faculty Publications

Initiation of Anti-Hypertensive Drugs and Outcomes in Patients With Heart Failure With Preserved Ejection Fraction and Persistent Hypertension

Phillip H. Lam, Veterans Affairs Medical Center, Washington, DC, USA; Georgetown University, Washington, DC, USA; MedStar Washington Hospital Center, Washington, DC, USA.
Apostolos Tsimploulis, Veterans Affairs Medical Center, Washington, DC, USA; Georgetown University, Washington, DC, USA; MedStar Washington Hospital Center, Washington, DC, USA.
Samir Patel, Veterans Affairs Medical Center, Washington, DC, USA; George Washington University, Washington, DC, USA.
Venkatesh K. Raman, Veterans Affairs Medical Center, Washington, DC, USA; Georgetown University, Washington, DC, USA.
Cherinne Arundel, Veterans Affairs Medical Center, Washington, DC, USA; George Washington University, Washington, DC, USA; Uniformed Services University, Washington, DC, USA.
Charles Faselis, Veterans Affairs Medical Center, Washington, DC, USA; George Washington University, Washington, DC, USA; Uniformed Services University, Washington, DC, USA.
Prakash Deedwania, Veterans Affairs Medical Center, Washington, DC, USA; University of California, San Francisco, CA, USA.
Farooq H. Sheikh, Georgetown University, Washington, DC, USA; MedStar Washington Hospital Center, Washington, DC, USA.
Sajal K. Banerjee, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh.
Richard M. Allman, Uniformed Services University, Washington, DC, USA; University of Alabama at Birmingham, Birmingham, AL, USA.
Gregg C. Fonarow, University of California, Los Angeles, CA, USA.
Wilbert S. Aronow, Westchester Medical Center and New York Medical College, Valhalla, NY, USA.
Ali Ahmed, Veterans Affairs Medical Center, Washington, DC, USA; Georgetown University, Washington, DC, USA; Uniformed Services University, Washington, DC, USA. Electronic address: ali.ahmed@va.gov.

Author Type(s)

Faculty

Journal Title

Progress in Cardiovascular Diseases

First Page

17

Last Page

23

Document Type

Article

Publication Date

1-1-2022

Department

Medicine

Abstract

BACKGROUND: National heart failure (HF) guidelines recommend that in patients with HF with preserved ejection fraction (EF;HFpEF) and hypertension, systolic blood pressure (SBP) should be maintained below 130 mmHg. The objective of the study is to examine the association between initiation of anti-hypertensive drugs and outcomes in patients with HFpEF with persistent hypertension. METHODS: Of the 8873 hospitalized patients with HFpEF (EF ≥50%) with a history of hypertension without renal failure in Medicare-linked OPTIMIZE-HF, 3315 had a discharge SBP ≥130 mmHg, of whom 1971 were not receiving anti-hypertensive drugs, thiazides and calcium channel blockers, before hospitalization. Of these, 366 received discharge prescriptions for those drugs. We assembled a propensity score-matched cohort of 365 pairs of patients initiated and not initiated on anti-hypertensive drugs, balanced on 37 baseline characteristics. Hazard ratios (HR) and 95% confidence intervals (CI) for outcomes associated with anti-hypertensive drug initiation were estimated in the matched cohort. RESULTS: Matched patients (n = 730) had a mean age of 78 years; 67% were women and 17% African Americans. During 6 (median 2.5) years of follow-up, 66% of the patients died and 45% had HF readmission. HRs (95% CIs) for all-cause mortality at 30 days, 12 months and 6 years associated with anti-hypertensive drug initiation were 0.64 (0.30-1.36), 0.70 (0.51-0.97), and 0.95 (0.79-1.13), respectively. Respective HRs (95% CIs) for HF readmission were 1.65 (0.97-2.80), 1.18 (0.90-1.56) and 1.09 (0.88-1.35). CONCLUSIONS: Among hospitalized older patients with HFpEF with uncontrolled hypertension, the initiation of therapy with anti-hypertensive drugs was not associated with all-cause mortality or hospital readmission.

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