Elsevier

JACC: Heart Failure

Volume 10, Issue 6, June 2022, Pages 380-392
JACC: Heart Failure

Mini-Focus Issue: Blood Pressure and Heart Failure
Apparent Treatment-Resistant Hypertension Across the Spectrum of Heart Failure Phenotypes in the Swedish HF Registry

https://doi.org/10.1016/j.jchf.2022.04.006Get rights and content
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Abstract

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.

Key Words

ejection fraction
heart failure
outcomes
registry
resistant hypertension

Abbreviations and Acronyms

ACE
angiotensin-converting enzyme
ARB
angiotensin receptor blocker
aTRH
apparent treatment-resistant hypertension
BMI
body mass index
eGFR
estimated glomerular filtration rate
HFmrEF
heart failure with mildly reduced ejection fraction
HFpEF
heart failure with preserved ejection fraction
HFrEF
heart failure with reduced ejection fraction
ICD-10
International Classification of Disease-10th Revision
LVEF
left ventricular ejection fraction
NYHA
New York Heart Association
TRH
treatment-resistant hypertension

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