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Background  Although diastolic blood pressure ( DBP ) is independently associated with an increased risk of adverse cardiovascular outcomes in the general population, it is unclear if a similar relationship exists in patients with heart failure with preserved ejection fraction.    Methods and Results  This analysis included 1703 (mean age, 72±10 years; 50% men; 78% white) patients with heart failure with preserved ejection fraction enrolled in the TOPCAT (Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist) Trial from the Americas who were treated for hypertension. Multivariable Cox regression was used to examine the risk of hospitalization for heart failure, death, and cardiovascular death associated with  DBP . The relationship between hospitalization for heart failure and  DBP  was linear, with an increased risk observed with decreasing  DBP  values (≥90 mm Hg: referent; 80–89 mm Hg: hazard ratio [HR], 1.44; 95% confidence interval [CI], 0.85–2.44; 70–79 mm Hg:  HR , 1.18; 95%  CI , 0.69–2.01; 60–69 mm Hg:  HR , 1.54; 95%  CI , 0.90–2.63; <60 mm Hg:  HR , 2.12; 95%  CI , 1.20–3.74;  P =0.0055 for trend). The associations of  DBP  with death (≥90 mm Hg:  HR , 1.86; 95%  CI , 1.12–3.06; 80–89 mm Hg:  HR , 1.23; 95%  CI , 0.89–1.70; 70–79 mm Hg: referent; 60–69 mm Hg:  HR , 1.20; 95%  CI , 0.90–1.59; <60 mm Hg:  HR , 1.68; 95%  CI , 1.21–2.33) and cardiovascular death (≥90 mm Hg:  HR , 2.02; 95%  CI , 1.10–3.71; 80–89 mm Hg:  HR , 1.17; 95%  CI , 0.77–1.79; 70–79 mm Hg: referent; 60–69 mm Hg:  HR , 1.16; 95%  CI , 0.80–1.70; <60 mm Hg:  HR , 1.85; 95%  CI , 1.21–2.82) were nonlinear, with a greater risk of each outcome observed with  DBP  values ≥90 and <60 mm Hg.    Conclusions   DBP  values ≥90 and <60 mm Hg are associated with a significant risk of adverse outcomes in patients with heart failure with preserved ejection fraction who are treated for hypertension. Further research is needed to determine optimal  DBP  targets to reduce the risk of adverse events in patients with heart failure with preserved ejection fraction.

journal of the american heart association

Diastolic Blood Pressure and Adverse Outcomes in the TOPCAT (Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist) Trial