Assessing cardiovascular benefits of intensive blood pressure lowering in high-risk undiagnosed HFpEF patients.

Aims: Heart failure with preserved ejection fraction (HFpEF) is often underdiagnosed. This study evaluates the HFpEF-ABA score's ability to identify high-risk, undiagnosed HFpEF subgroups with elevated cardiovascular event rates and assesses the impact of intensive blood pressure control in these populations.

Methods: A post-hoc analysis of the Systolic Blood Pressure Intervention Trial (SPRINT) was performed. The HFpEF-ABA score identified high-risk individuals with undiagnosed HFpEF. Cox proportional hazards regression was used to examine interactions between HFpEF-ABA score groups and intensive blood pressure control on major cardiovascular outcomes. The primary outcome was a composite of myocardial infarction (MI), acute coronary syndrome not resulting in MI, stroke, acute decompensated heart failure and cardiovascular disease death.

Results: Among 9265 patients (mean age, 67.9 ± 9.4 years; 35.5% females), 559 primary outcomes occurred during a median follow-up of 3.2 years. An HFpEF-ABA score ≥ 90% was associated with a higher risk of the primary outcome [adjusted hazard ratio (aHR), 1.96 (1.57-2.44); P < 0.001]. When treated as a continuous variable, higher HFpEF-ABA scores were independently associated with an increased risk of the primary composite outcome (P = 0.001), with a modest non-linear relationship observed (P for non-linearity = 0.040). In the intensive treatment group, the absolute reduction in primary outcomes was 5.0 per 1000 patient-years for scores < 90% and 11.2 per 1000 patient-years for ≥ 90%. Intensive blood pressure control reduced primary outcomes in both groups [<90%: aHR, 0.75 (0.62-0.90); ≥90%: aHR, 0.76 (0.51-1.13)] with no significant heterogeneity (P for interaction = 0.944). Serious adverse events did not increase in either group [<90%: aHR, 1.04 (0.96-1.11); ≥90%: aHR, 1.06 (0.88-1.28); P for interaction = 0.801].

Conclusions: The HFpEF-ABA score identifies high-risk patients with undiagnosed HFpEF who have elevated cardiovascular event rates and benefit from intensive blood pressure control without an increased risk of serious adverse events.