In patients with heart failure with preserved ejection fraction (HFpEF), both baseline and mean achieved systolic blood pressure (SBP) of 120-129 mm Hg identified patients at the lowest risk for cardiovascular outcomes, according to results of the PARAGON-HF trial presented during ACC.20/WCC and simultaneously published in the Journal of the American College of Cardiology. In addition, baseline SBP did not modify the treatment effect of sacubitril/valsartan.

Senthil Selvaraj, MD, MA, et al., sought to assess whether BP lowering is associated with clinical benefit in HFpEF and whether the treatment effects of sacubitril/valsartan on outcomes are related to BP lowering, particularly among women who derive greater benefit from sacubitril/valsartan. Using data from 4,795 trial participants, the authors associated baseline and time-updated mean achieved SBP to the primary outcome, its components and a renal composite outcome.

Results showed that after multivariable adjustment, baseline and mean achieved SBP 120-129 mm Hg demonstrated the lowest risk for all outcomes. The authors note that lowering SBP was associated with a modest reduction in N-terminal pro-B-type natriuretic peptide, but not with quality of life.

Furthermore, sacubitril/valsartan was found to consistently reduce SBP by 5.2 mm Hg (95 percent confidence interval, 4.4 to 6.0 mm Hg) compared with valsartan at four weeks. However, the association between sacubitril/valsartan and the primary outcome was not modified by baseline SBP and was similar when adjusting for time-updated SBP, irrespective of sex.

"Our analyses provide new insight into the relationship of baseline, and mean achieved, SBP and outcomes in HFpEF, and further suggest that SBP reduction with sacubitril/valsartan is not responsible for its treatment benefits in HFpEF in both women and men."

Clinical Topics: Heart Failure and Cardiomyopathies, Acute Heart Failure

Keywords: ACC Annual Scientific Session, acc20, Heart Failure, Blood Pressure, Stroke Volume, Quality of Life

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