Heart failure & cardiomyopathiesMeta-analysis
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
- Pooled participant-level analysis of four randomised trials
- landmark analysis
- adjusted for baseline CV risk factors
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)
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:10.1093/ejhf/xuag245
Summarised from the published abstract; every number is checked against it