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Safety and Efficacy of Anti-Hypertensive Medications in Patients with Heart Failure with Preserved Ejection Fraction: A Systematic Review and Meta-analysis

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Abstract

Introduction

Hypertension (HTN) is a co-morbidity that is commonly associated with heart failure with preserved ejection fraction (HFpEF). However, it remains unclear whether treatment of hypertension in HFpEF patients is associated with improved cardiovascular outcomes.

Aim

The purpose of this meta-analysis is to evaluate the association of anti-hypertensive medical therapy with cardiovascular outcomes in patients with HFpEF.

Methods

We performed a database search for studies reporting on the association of anti-hypertensive medications with cardiovascular outcomes and safety endpoints in patients with HFpEF. The databases searched include OVID Medline, Web of Science, and Embase. The primary endpoint was all-cause mortality. Secondary endpoints include cardiovascular (CV) mortality, worsening heart failure (HF), CV hospitalization, composite major adverse cardiovascular events (MACE), hyperkalemia, worsening renal function, and hypotension.

Results

A total of 12 studies with 14062 HFpEF participants (7010 treated with medical therapy versus 7052 treated with placebo) met inclusion criteria. Use of anti-hypertensive medications was not associated with lower all-cause mortality, CV mortality or CV hospitalization compared to treatment with placebo (OR 1.02, 95% CI 0.77–1.35; p = 0.9, OR 0.88, 95% CI 0.73–1.06; p = 0.19, OR 0.99, 95% CI 0.87–1.12; p = 0.83, OR 0.90, 95% CI 0.79–1.03; p = 0.11). Anti-hypertensive medications were not associated with lower risk of subsequent acute myocardial infarction (AMI) (OR 0.53, 95% CI 0.07–3.73; p = 0.5). Use of anti-hypertensive medications was associated with a statistically significant lower risk of MACE (OR 0.90, 95% CI 0.83–0.98; p = 0.02).

Conclusions

While treatment with anti-hypertensive medications was not associated with lower risk of all-cause mortality, their use may be associated with reduce risk of adverse cardiovascular outcomes in patients with HFpEF regardless of whether they have HTN. Additional high quality studies are required to clarify this association and determine the effect based on specific classes of medications.

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Authors and Affiliations

  1. University of Michigan Hospital, 1500 E Medical Center Dr, Ann Arbor, MI, 48109, USA

    Mohammed Al-Sadawi

  2. Stony Brook University Hospital, 101 Nicolls Rd, Stony Brook, NY, 11794, USA

    Michael Tao, Simrat Dhaliwal, Mark Goldschmit, Edlira Tam & Noel Mann

Authors
  1. Mohammed Al-Sadawi
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  2. Michael Tao
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  3. Simrat Dhaliwal
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  4. Mark Goldschmit
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  5. Edlira Tam
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  6. Noel Mann
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Corresponding author

Correspondence to Mohammed Al-Sadawi.

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The authors report no relevant conflicts of interest.

Compliance with ethical standards (guidelines statement)

The systematic review was conducted with a protocol in accordance with the Preferred Reporting of Items for Systematic reviews and Meta-Analyses (PRISMA) statement.

Ethical approval

The study is a systematic review and meta-analysis; no ethical approval was required.

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Al-Sadawi, M., Tao, M., Dhaliwal, S. et al. Safety and Efficacy of Anti-Hypertensive Medications in Patients with Heart Failure with Preserved Ejection Fraction: A Systematic Review and Meta-analysis. High Blood Press Cardiovasc Prev (2024). https://doi.org/10.1007/s40292-024-00646-0

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  • DOI: https://doi.org/10.1007/s40292-024-00646-0

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