Association of long-term SBP with clinical outcomes and quality of life in heart failure with preserved ejection fraction: an analysis of the Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist trial.

AIMS To determine the associations of long-term SBP (LT-SBP) levels with clinical outcomes and health-related quality of life in heart failure with preserved ejection fraction (HFpEF). METHODS AND RESULTS We analyzed participants from the Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist (TOPCAT) study with available different SBP measurements from different follow-ups (n = 3310). LT-SBP was the mean SBP value from 4-week measurement to the last one. The outcome measures are all-cause mortality and a composite of heart failure readmission or all-cause mortality and the Kansas City Cardiomyopathy Questionnaire (KCCQ) overall summary score. To determine the associations of LT-SBP and outcomes, we used adjusted Cox proportional hazards models and restricted cubic spline models. After multivariable adjustment, LT-SBP of 120-129 and 130-139 mmHg were associated with a lower risk of mortality (hazard ratio 0.66, 95% CI 0.51-0.87, P = 0.003; hazard ratio 0.68, 95% CI 0.51-0.90, P = 0.007, respectively); LT-SBP of 100-119 mmHg had similar risk of mortality (hazard ratio 0.96, 95% CI 0.72-1.28, P = 0.778) compared with LT-SBP of at least 140 mmHg. There was U-shaped relationship between LT-SBP and all-cause mortality (P < 0.001) with nadir risk occurring around 123 mmHg. Similar relationships were observed between LT-SBP and composite end point of heart failure readmission or all-cause mortality. The adjusted mean improvement in KCCQ score was significantly higher in the 120-129 mmHg group than in the at least 140 mmHg group beginning from the 12-month follow-up visit without significant differences in other groups. CONCLUSION Among patients with HFpEF, long-term control of SBP level at 120-129 mmHg is independently associated with the highest risk reduction of all-cause mortality and improvement of KCCQ score. Future randomized clinical trials need to specifically evaluate optimal SBP treatment goals in patients with HFpEF.