TY  - JOUR
ID  - enlighten272803
UR  - https://eprints.gla.ac.uk/272803/
IS  - 6
A1  - Jackson, Alice M.
A1  - Benson, Lina
A1  - Savarese, Gianluigi
A1  - Hage, Camilla
A1  - Jhund, Pardeep S.
A1  - Petrie, Mark C.
A1  - Dahlstr�m, Ulf
A1  - McMurray, John J.V.
A1  - Lund, Lars H.
Y1  - 2022/06//
N2  - 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.
PB  - Elsevier
JF  - JACC: Heart Failure
VL  - 10
SN  - 2213-1779
TI  - Apparent treatment-resistant hypertension across the spectrum of heart failure phenotypes in the Swedish HF Registry
SP  - 380
AV  - none
EP  - 392
ER  -