More time in target BP range may improve outcomes in HFpEF: TOPCAT secondary analysis
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Increased time in target systolic BP range of 110 mm Hg to 130 mm Hg was associated with lower CV mortality, aborted cardiac arrest or HF hospitalization in patients with HF with preserved ejection fraction, researchers reported.
The analysis, published in the Journal of the American Heart Association, is a secondary analysis of the TOPCAT trial, a randomized, placebo-controlled study that evaluated the use of spironolactone for the treatment of HFpEF compared with placebo.
“Little medical intervention has been proved to alter mortality outcome in HFpEF, and therefore treatment is mainly focused on management of comorbidities,” Rihua Huang, PhD, of the cardiology department at the First Affiliated Hospital of Sun Yat-Sen University and NHC Key Laboratory of Assisted Circulation, Sun Yat-Sen University in Guangzhou, China, and colleagues wrote. “It is conjectured that controlling blood pressure in a specific target range might help to achieve the maximum benefit. Time in target range of systolic BP is a value that estimates the time with systolic BP within target range and characterize the extent of blood pressure control. In this study, we aimed to evaluate the association between time in target range of systolic BP and risk of clinical outcomes among patients with HFpEF, using data from the TOPCAT trial.”
The TOPCAT trial
As Healio previously reported, spironolactone failed to significantly reduce occurrence of the composite primary endpoint of CV mortality, aborted cardiac arrest or HF hospitalization in patients with HFpEF compared with placebo in the TOPCAT trial.
For the present analysis, researchers evaluated whether the duration of time within the target BP range of 110 mm Hg and 130 mm Hg during the first 4 months of participants in the TOPCAT trial had any effect on the occurrence of the composite primary endpoint.
Participants were stratified based on proportion of time in target BP range: 0% to 25%, 25% to 50%, 50% to 75% and 75% to 100%.
Researchers included 3,194 participants with HFpEF from the TOPCAT study (mean age, 68 years; 51% women; 90% white; 91% with hypertension).
Time in target BP range and TOPCAT outcomes
Researchers observed that participants with greater time in target range were more often younger and white with lower BMI and NYHA class compared with individuals with a time in target range of 0% to 25%.
In the adjusted analysis, which also accounted for mean BP, each standard deviation increment (38.3%) of time in target BP range was associated with lower risk for the primary composite endpoint (HR = 0.8; 95% CI, 0.72-0.88; P < .001).
After adjustment for additional confounders, researchers reported that increased time in the target BP range of 110 mm Hg to 130 mm Hg was associated with lower risk for all-cause mortality (HR = 0.79; 95% CI, 0.71-0.88; P < .001), CV death (HR = 0.77; 95% CI, 0.67-0.88; P < .001) and HF hospitalization (HR = 0.83; 95% CI, 0.73-0.94; P = .003).
The association between time in target BP range and clinical outcomes was stronger in younger adults than in older adults (P for interaction = .028), according to the researchers.
“The findings of our study are of major clinical importance for blood pressure control of patients with HFpEF,” the researchers wrote.
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