New hypertension and heart failure guidelines recommend that systolic blood pressure (SBP) in patients with heart failure with preserved ejection fraction (HFpEF) and hypertension be lowered to <130 mmHg.
Of the 6778 hospitalized patients with HFpEF and a history of hypertension in the Medicare-linked OPTIMIZE-HF registry, 3111 had a discharge SBP <130 mmHg. Using propensity scores for SBP <130 mmHg, we assembled a matched cohort of 1979 pairs with SBP <130 versus ≥130 mmHg, balanced on 66 baseline characteristics (mean age, 79 years; 69% women; 12% African American). We then assembled a second matched cohort of 1326 pairs with SBP <120 versus ≥130 mmHg. Hazard ratios (HRs) and 95% confidence intervals (CIs) for outcomes associated with SBP <130 and <120 mmHg were separately estimated in the matched cohort using SBP ≥130 mmHg as the reference.
HRs (95% CIs) for 30-day, 12-month, and 6-year all-cause mortality associated with SBP <130 mmHg were 1.20 (0.91-1.59; p=0.200), 1.11 (0.99-1.26; p=0.080), and 1.05 (0.98-1.14; p=0.186), respectively. Respective HRs (95% CIs) associated with SBP <120 mmHg were 1.68 (1.21-2.34; p=0.002), 1.28 (1.11-1.48; p=0.001), and 1.11 (1.02-1.22; p=0.022). There was no association with readmission.
Among older patients with HFpEF and hypertension, compared with SBP ≥130 mmHg, the new target SBP <130 mmHg had no association with outcomes, but SBP <120 mmHg was associated with a higher risk of death but not of readmission. Future prospective studies need to evaluate optimal SBP treatment goals in these patients.

Published by Elsevier Inc.