Heart failure & cardiomyopathies
Time in blood pressure range and cardiovascular outcomes in HF with mildly reduced EF (HFmrEF)/heart failure with preserved ejection fraction (HFpEF): a pooled participant-level analysis of four large-scale trials
Authors' conclusion
In patients with HFmrEF/HFpEF, BP control during the first year was associated with a lower subsequent risk of HF hospitalization.
Study context
- Population
- Patients with HFmrEF/HFpEF (LVEF >40%, ≥40% or ≥45%) in TOPCAT (Americas), PARAGON-HF, DELIVER and FINEARTS-HF
- Participants
- 17,788 patients · 4 trials
- Comparison
- Time in systolic BP (SBP) target range during first year after randomisation
- Outcome
- HF hospitalization or CV death (continuous association with TIR)
Methodological detailslandmark analysis, adjusted for baseline CV risk factors
- Landmark analysis
- Adjusted for baseline CV risk factors
Pooled result
As reported in the abstract
HF hospitalization or CV death vs TIR
Higher TIR associated with lower subsequent risk of composite outcome
P=0.021
Further pooled results
Effect of randomised active therapy on TIR
| Comparison | TIR increase (95% CI) | |
|---|---|---|
| Spironolactone | 2% (−2 to 6) | |
| Sacubitril/valsartan | 7% (5–9) | |
| Dapagliflozin | 2% (0–4) | |
| Finerenone | 3% (1–5) | |
| −50510Difference (linear scale) |
HF hospitalization
- Higher TIR associated with lower HF hospitalization risk
- P = 0.007
CV death and all-cause death
- Associations not significant
Sensitivity analyses (120-<130, 100-<130, 120-<140 mmHg)
- Qualitatively similar findings
Original publication
Time in blood pressure range and cardiovascular outcomes in HFmrEF/HFpEF: a pooled participant-level analysis of four large-scale trials. Eur J Heart Fail. Published 30 August 2026. doi:10.
Summarised from the published abstract; every number is checked against it