Abstract Body: Background: Heart failure (HF) with preserved ejection fraction (HFpEF) affects engenders high morbidity and mortality. Hypertension is a major risk factor for HFpEF progression. We aimed to evaluate the prevalence of and factors associated with abnormal home blood pressure (BP) phenotypes in a trial cohort of individuals with hypertension and HFpEF.
Methods: We evaluated baseline office and home BP measurements in 36 participants of BLOCK HFpEF, an ongoing trial of antihypertensive treatment in HFpEF (NCT04434664). Office BP was measured using a standardized approach with the average of 3 seated readings. Home BP was measured for the first 7 days of the trial, prior to initiating the intervention. Participants were asked to perform nocturnal home BP one night, taken 3 times while sleeping. We used a conservative threshold for controlled BPs, defined as office systolic BP (SBP) <140 mmHg, office diastolic BP (DBP) <90 mmHg, home daytime SBP <135 mmHg, and home daytime DBP <85 mmHg. White coat effect was defined as elevated office and controlled home BP. Masked uncontrolled hypertension was defined as controlled office and elevated home BP. Sustained hypertension was defined as controlled office and elevated home BP. Nocturnal hypertension was defined as nighttime SBP ≥120 mmHg or DBP ≥70 mmHg.
Results: Of the 36 participants with home BP data, 7 (19%) had controlled hypertension, 6 (17%) had white coat effect, 6 (17%) had masked uncontrolled hypertension, and 17 (47%) had sustained hypertension. 27 participants completed nighttime home BP readings, among whom 23 (85%) had nocturnal hypertension. Of those with nocturnal hypertension, 2 (9%) had controlled hypertension based on their daytime home BPs, 3 (13%) had white coat effect, 5 (22%) had masked uncontrolled hypertension, and 13 (56%) had sustained hypertension. There was no significant difference in age, sex, race, history of atrial fibrillation, and history of diabetes mellitus across BP phenotypes. The mean number of cardiology visits in the two years before enrollment was 4.3 (SD 2.8), which did not differ across home BP phenotypes.
Conclusion: Masked uncontrolled hypertension and nocturnal hypertension were common in patients enrolled in the BLOCK HFpEF trial. These home BP phenotypes cannot be determined using office BP alone. While this is a small sample, patients with HFpEF may particularly benefit from careful BP phenotyping using out-of-office monitoring, including nocturnal BP monitoring.