Clinical Significance of Mean and Pulse Pressure in Patients With Heart Failure With Preserved Ejection Fraction

Author:

Wei Fang-Fei12ORCID,Wu Yuzhong12,Xue Ruicong12,Liu Xiao3,He Xin12,Dong Bin12,Zhen Zhe12,Chen Xuwei12,Liang Weihao12ORCID,Zhao Jingjing12,He Jiangui12,Dong Yugang124,Staessen Jan A.56ORCID,Liu Chen124ORCID

Affiliation:

1. Department of Cardiology, the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China (F.-F.W., Y.W., R.X., X.H., B.D., Z.Z., X.C., W.L., J.Z., J.H., Y.D., C.L.).

2. NHC Key Laboratory of Assisted Circulation, Sun Yat-Sen University, Guangzhou, China (F.-F.W., Y.W., R.X., X.H., B.D., Z.Z., X.C., W.L., J.Z., J.H., Y.D., C.L.).

3. Department of Cardiology, the Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China (X.L.).

4. National Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Disease, Guangzhou, China (Y.D., C.L.).

5. Research Institute Alliance for the Promotion of Preventive Medicine, Mechelen, Belgium (J.A.S.).

6. Biomedical Science Group, University of Leuven, Belgium (J.A.S.).

Abstract

It remains debated whether pulse pressure is associated with left ventricular traits and adverse outcomes over and beyond mean arterial pressure (MAP) in patients with heart failure (HF) with preserved ejection fraction. We investigated these associations in 3428 patients with HF with preserved ejection fraction (51.5% women; mean age, 68.6 years) enrolled in the TOPCAT trial (Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist). We computed association sizes and hazards ratios with 1-SD increase in MAP and pulse pressure. In multivariable-adjusted analyses, association sizes ( P ≤0.039) for MAP were 0.016 cm and 0.014 cm for septal and posterior wall thickness, −0.15 for E/A ratio, −0.66 for E/e′, and −0.64% for ejection fraction, independent of pulse pressure. With adjustment additionally applied for MAP, E/A ratio and longitudinal strain increased with higher pulse pressure with association sizes amounting to 0.067 ( P =0.026) and 0.40% ( P =0.023). In multivariable-adjusted analyses of both placebo and spironolactone groups, lower MAP and higher pulse pressure predicted the primary composite end point ( P ≤0.028) and hospitalized HF ( P ≤0.002), whereas MAP was also significantly associated with total mortality ( P ≤0.007). Sensitivity analyses stratified by sex, median age, and region generated confirmatory results with exception for the association of adverse outcomes with pulse pressure in patients with age ≥69 years. In conclusion, the clinical application of MAP and pulse pressure may refine risk estimates in patients with HF with preserved ejection fraction. This finding may help further investigation for the development of HF with preserved ejection fraction preventive strategies targeting pulsatility and blood pressure control.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Internal Medicine

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