Apparent treatment-resistant hypertension across the spectrum of heart failure phenotypes in the Swedish HF Registry (original) (raw)

Jackson, Alice M., Benson, Lina, Savarese, Gianluigi, Hage, Camilla, Jhund, Pardeep S. ORCID: https://orcid.org/0000-0003-4306-5317, Petrie, Mark C. ORCID: https://orcid.org/0000-0002-6333-9496, Dahlström, Ulf, McMurray, John J.V. ORCID: https://orcid.org/0000-0002-6317-3975 and Lund, Lars H.(2022) Apparent treatment-resistant hypertension across the spectrum of heart failure phenotypes in the Swedish HF Registry.JACC: Heart Failure, 10(6), pp. 380-392. (doi: 10.1016/j.jchf.2022.04.006) (PMID:35654522)

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Abstract

Background: Hypertension is common in patients with heart failure (HF), but less is known about resistant hypertension. Objectives: This study sought to investigate apparent treatment-resistant hypertension (aTRH) in patients with HF in the SwedeHF (Swedish Heart Failure Registry), across the spectrum of HF phenotypes (heart failure with reduced ejection fraction [HFrEF], heart failure with mildly reduced ejection fraction [HFmrEF], and heart failure with preserved ejection fraction [HFpEF]). Methods: aTRH was defined as systolic blood pressure ≥140 mm Hg (≥135 mm Hg in diabetes) despite treatment with an angiotensin-converting enzyme inhibitor, angiotensin receptor blocker, or sacubitril-valsartan, as well as a calcium-channel blocker and a diuretic; non–treatment-resistant hypertension (TRH) was defined as systolic blood pressure above these thresholds but not on the 3-drug combination; and normal blood pressure was defined as under these thresholds. In each left ventricular ejection fraction (LVEF) category, patient factors associated with aTRH and non-TRH and outcomes (HF hospitalization and cardiovascular death composite, its components, and all-cause death) according to hypertension category were examined. Results: Among 46,597 patients, aTRH was present in 2,693 (10%), 1,514 (14%), and 1,450 (17%) patients with HFrEF, HFmrEF, and HFpEF, respectively. Older age, obesity, diabetes, and kidney disease were associated with a greater likelihood of aTRH and non-TRH (vs normal blood pressure). Associations were generally similar irrespective of LVEF category. Compared with normal blood pressure, aTRH was associated with a lower adjusted risk of the composite outcome in HFrEF and HFmrEF (HR: 0.79 [95% CI: 0.74-0.85] and HR: 0.86 [95% CI: 0.77-0.96]) but not in HFpEF (HR: 0.93 [95% CI: 0.84-1.04]). Conclusions: aTRH was most common in HFpEF and least common in HFrEF. Associated patient characteristics were similar irrespective of LVEF category. aTRH (vs normal blood pressure) was associated with a lower risk of first HF hospitalization or cardiovascular death in HFrEF and HFmrEF but not in HFpEF.

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