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Abstract: PO2108

Control of Blood Pressure in Elderly Patients with Heart Failure and Risk of Mortality

Session Information

Category: Hypertension and CVD

  • 1402 Hypertension and CVD: Clinical, Outcomes, and Trials

Authors

  • Douros, Antonios, McGill University, Montreal, Quebec, Canada
  • Schneider, Alice, Charite Universitatsmedizin Berlin, Berlin, Berlin, Germany
  • Ebert, Natalie, Charite Universitatsmedizin Berlin, Berlin, Berlin, Germany
  • Kuhlmann, Martin K., Vivantes-Netzwerk fur Gesundheit GmbH, Berlin, Berlin, Germany
  • Mielke, Nina, Charite Universitatsmedizin Berlin, Berlin, Berlin, Germany
  • van der Giet, Markus, Charite Universitatsmedizin Berlin, Berlin, Berlin, Germany
  • Schaeffner, Elke, Charite Universitatsmedizin Berlin, Berlin, Berlin, Germany
Background

Blood pressure (BP) targets in elderly patients with heart failure (HF) are unclear and guidelines are based on expert consensus and extrapolation from populations without HF. Thus, our population-based prospective cohort study assessed if BP control <140/90 mmHg is associated with a decreased risk of mortality in elderly HF patients.

Methods

We included participants of the Berlin Initiative Study, all ≥70 yrs, with HF and treated with antihypertensive drugs at baseline (2009-2011). Demographics, lifestyle factors, medication, and comorbidities were obtained in face-to-face interviews and linked with administrative healthcare data. BP status was defined as normalized BP (systolic BP <140 and diastolic BP <90 mmHg) or non-normalized BP (systolic BP ≥140 or diastolic BP ≥90 mmHg) and updated every 2 yrs, so that each patient could contribute person-time to both exposure categories during follow-up. Time-dependent Cox proportional hazards models estimated adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) of cardiovascular death and all-cause mortality associated with normalized BP compared with non-normalized BP in HF patients. Analyses were repeated in non-HF patients.

Results

There were 544 HF patients treated with antihypertensive drugs (mean age 82.8 yrs; 45.4% female). During a median f/up of 7.5 yrs and compared with non-normalized BP, normalized BP was associated with an increased risk of cardiovascular death (HR, 1.79; 95% CI, 1.23-2.61) and all-cause mortality (HR, 1.48; 95% CI, 1.15-1.90). No increased risks of cardiovascular death (HR, 1.23; 95% CI, 0.87-1.74) or all-cause mortality (HR, 1.19; CI 0.95-1.49) associated with normalized BP were observed among 1079 non-HF patients.

Conclusion

BP <140/90 mmHg was not associated with a decreased risk of mortality in elderly HF patients. The increased risk requires further confirmation.

Risk of cardiovascular death and all-cause mortality associated with normalized BP in older adults with HF
 Number of eventsPerson-yearsIncidence rate (per 100 person-years)
Crude HR (95% CI)Adjusted HR (95% CI)
Cardiovascular death     
Non-normalized BP5617213.3Ref.Ref.
Normalized BP8015465.31.57 (1.12-2.21)1.79 (1.23-2.61)
All-cause mortality     
Non-normalized BP12817517.3Ref.Ref.
Normalized BP167156710.71.44 (1.14-1.81)1.48 (1.15-1.90)

Funding

  • Private Foundation Support