Control of blood pressure in older patients with heart failure and the risk of mortality: a population-based prospective cohort study

Background: treatment goals for blood pressure (BP) lowering in older patients with heart failure (HF) are unclear. Objective: to assess whether BP control < 140/90 mmHg is associated with a decreased risk of mortality in older HF patients. Design: population-based prospective cohort study. Setting/subjects: participants of the Berlin Initiative Study, a prospective cohort of community-dwelling older adults launched in 2009. Clinical information was obtained in face-to-face interviews and linked to administrative healthcare data. Methods: Cox proportional hazards models estimated adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) of cardiovascular death and all-cause mortality associated with normalised BP (systolic BP < 140 mmHg and diastolic BP < 90 mmHg) compared with non-normalised BP (systolic BP >= 140 mmHg or diastolic BP >= 90 mmHg) in HF patients. The primary analysis considered only baseline BP (`time-fixed'); an additional analysis updated BP during follow-up ('time-dependent'). Results: at baseline, 544 patients were diagnosed with HF and treated with antihypertensive drugs (mean age 82.8 years; 45.4% female). During a median follow-up of 7.5 years and compared with non-normalised BP, normalised BP was associated with similar risks of cardiovascular death (HR, 1.24; 95% CI, 0.84-1.85) and all-cause mortality (HR, 1.16; 95% CI, 0.89-1.51) in the time-fixed analysis but with increased risks 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) in the time-dependent analysis. Conclusions: BP control < 140/90 mmHg was not associated with a decreased risk of mortality in older HF patients. The increased risk in the time-dependent analysis requires further corroboration.

Automated summary

In older patients with heart failure, blood pressure control below 140/90 mmHg was not associated with a decreased risk of mortality. However, normalization of blood pressure during follow-up may increase the risks of cardiovascular death and all-cause mortality.