Page 3 - hypertension_newsletter8

REFLECTIONS
Hypertension
Hypertension Global Newsletter #8 2025

A total of 186 cases of HF (3.61%; incidence rate, 6.03; 95% confidence interval [CI], 5.23–6.97) occurred. The incidence rate of
HF decreased with higher SBP TTR, from 8.06 (95% CI, 6.07–10.69) in the 0% to <25% group to 4.32 (95% CI, 2.85–6.57) in the
75% to 100% group. After adjustment for potential variables, greater SBP TTR remained associated with a lower risk of incident HF.
Hypertension
Participants in the SBP TTR of 75% to 100% group
had a 47% (hazard ratio [HR], 0.53; 95% CI, 0.32– Cumulative incidence of heart failure by SBP TTR
0.89) lower risk of incident HF, compared with those
in SBP TTR of 0% to <25%.

Interestingly, the authors found that participants in the
SBP of 50% to <75% group had a potentially higher
risk of HF compared to those in the 25% to <50%
group. Possible reasons for this discrepancy included
an older patient population for the 50% to <75% group,
large sample size compared to the other groupings,
and that the association between SBP and the risk of
HF may not be linear as previously reported.

The addition of SBP TTR, rather than mean SBP
and SBP variation, to a conventional risk model had
an incremental effect on the predictive value for HF,
with an integrated discrimination improvement (IDI)
value of 0.31% (P = 0.0003) and category-free net
reclassification improvement (NRI) value of 19.79%
(P = 0.0081).

The results showed not only an inverse association between 24-hour SBP TTR and incident HF risk but also consistent associations
across subgroups, regardless of hypertension status or antihypertensive treatment. This highlights the benefit of keeping SBP under
control, even in the short-term, in preventing HF.

The authors concluded that a higher 24-hour SBP TTR was significantly associated with a lower risk of incident HF in the general
population, which was superior to mean SBP and SBP variability in predicting the risk of HF. This indicates that efforts to attain SBP
within 110–140 mmHg may be an effective strategy to prevent HF. Future randomised controlled trials are warranted to explore the
efficacy and safety of antihypertensive agents in the control of 24-hour SBP TTR.

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