{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T17:48:45Z","timestamp":1792172925168,"version":"4.4.0"},"reference-count":17,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"5","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2018,3,6]]},"abstract":"\n Background<\/jats:title>\n \n Although diastolic blood pressure (\n DBP<\/jats:styled-content>\n ) 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.\n <\/jats:p>\n <\/jats:sec>\n \n Methods and Results<\/jats:title>\n \n This analysis included 1703 (mean age, 72\u00b110\u00a0years; 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\n DBP<\/jats:styled-content>\n . The relationship between hospitalization for heart failure and\n DBP<\/jats:styled-content>\n was linear, with an increased risk observed with decreasing\n DBP<\/jats:styled-content>\n values (\u226590\u00a0mm\u00a0Hg: referent; 80\u201389\u00a0mm\u00a0Hg: hazard ratio [HR], 1.44; 95% confidence interval [CI], 0.85\u20132.44; 70\u201379\u00a0mm\u00a0Hg:\n HR<\/jats:styled-content>\n , 1.18; 95%\n CI<\/jats:styled-content>\n , 0.69\u20132.01; 60\u201369\u00a0mm\u00a0Hg:\n HR<\/jats:styled-content>\n , 1.54; 95%\n CI<\/jats:styled-content>\n , 0.90\u20132.63; <60\u00a0mm\u00a0Hg:\n HR<\/jats:styled-content>\n , 2.12; 95%\n CI<\/jats:styled-content>\n , 1.20\u20133.74;\n P<\/jats:italic>\n =0.0055 for trend). The associations of\n DBP<\/jats:styled-content>\n with death (\u226590\u00a0mm\u00a0Hg:\n HR<\/jats:styled-content>\n , 1.86; 95%\n CI<\/jats:styled-content>\n , 1.12\u20133.06; 80\u201389\u00a0mm\u00a0Hg:\n HR<\/jats:styled-content>\n , 1.23; 95%\n CI<\/jats:styled-content>\n , 0.89\u20131.70; 70\u201379\u00a0mm\u00a0Hg: referent; 60\u201369\u00a0mm\u00a0Hg:\n HR<\/jats:styled-content>\n , 1.20; 95%\n CI<\/jats:styled-content>\n , 0.90\u20131.59; <60\u00a0mm\u00a0Hg:\n HR<\/jats:styled-content>\n , 1.68; 95%\n CI<\/jats:styled-content>\n , 1.21\u20132.33) and cardiovascular death (\u226590\u00a0mm\u00a0Hg:\n HR<\/jats:styled-content>\n , 2.02; 95%\n CI<\/jats:styled-content>\n , 1.10\u20133.71; 80\u201389\u00a0mm\u00a0Hg:\n HR<\/jats:styled-content>\n , 1.17; 95%\n CI<\/jats:styled-content>\n , 0.77\u20131.79; 70\u201379\u00a0mm\u00a0Hg: referent; 60\u201369\u00a0mm\u00a0Hg:\n HR<\/jats:styled-content>\n , 1.16; 95%\n CI<\/jats:styled-content>\n , 0.80\u20131.70; <60\u00a0mm\u00a0Hg:\n HR<\/jats:styled-content>\n , 1.85; 95%\n CI<\/jats:styled-content>\n , 1.21\u20132.82) were nonlinear, with a greater risk of each outcome observed with\n DBP<\/jats:styled-content>\n values \u226590 and <60\u00a0mm\u00a0Hg.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n \n DBP<\/jats:styled-content>\n values \u226590 and <60\u00a0mm\u00a0Hg 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\n DBP<\/jats:styled-content>\n targets to reduce the risk of adverse events in patients with heart failure with preserved ejection fraction.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1161\/jaha.117.007475","type":"journal-article","created":{"date-parts":[[2018,2,24]],"date-time":"2018-02-24T01:10:22Z","timestamp":1519434622000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":31,"title":["Diastolic Blood Pressure and Adverse Outcomes in the TOPCAT (Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist) Trial"],"prefix":"10.1161","volume":"7","author":[{"given":"Pratik B.","family":"Sandesara","sequence":"first","affiliation":[{"name":"Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wesley T.","family":"O'Neal","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heval M.","family":"Kelli","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew","family":"Topel","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ayman","family":"Samman\u2010Tahhan","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laurence S.","family":"Sperling","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_4_2_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.116.021884"},{"key":"e_1_3_4_3_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCRESAHA.115.302922"},{"key":"e_1_3_4_4_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1996.03530440037034"},{"key":"e_1_3_4_5_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCHEARTFAILURE.115.003116"},{"key":"e_1_3_4_6_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000509"},{"key":"e_1_3_4_7_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1511939"},{"key":"e_1_3_4_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(16)31326-5"},{"key":"e_1_3_4_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2016.07.754"},{"key":"e_1_3_4_10_2","unstructured":"Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist (TOPCAT). https:\/\/biolincc.nhlbi.nih.gov\/studies\/topcat. Accessed October 26 2016."},{"issue":"966","key":"e_1_3_4_11_2","first-page":"e10","article-title":"Rationale and design of the treatment of preserved cardiac function heart failure with an aldosterone antagonist trial: a randomized, controlled study of spironolactone in patients with symptomatic heart failure and preserved ejection fraction","volume":"162","author":"Desai AS","year":"2011","unstructured":"Desai AS, Lewis EF, Li R, Solomon SD, Assmann SF, Boineau R, Clausell N, Diaz R, Fleg JL, Gordeev I, McKinlay S, O'Meara E, Shaburishvili T, Pitt B, Pfeffer MA. Rationale and design of the treatment of preserved cardiac function heart failure with an aldosterone antagonist trial: a randomized, controlled study of spironolactone in patients with symptomatic heart failure and preserved ejection fraction. Am Heart J. 2011;162(966\u2013972):e10.","journal-title":"Am Heart J"},{"key":"e_1_3_4_12_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCHEARTFAILURE.112.972794"},{"key":"e_1_3_4_13_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.114.013255"},{"key":"e_1_3_4_14_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1313731"},{"key":"e_1_3_4_15_2","doi-asserted-by":"publisher","DOI":"10.1002\/sim.3841"},{"key":"e_1_3_4_16_2","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-144-12-200606200-00005"},{"key":"e_1_3_4_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2017.07.094"},{"key":"e_1_3_4_18_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2013.284427"}],"container-title":["Journal of the American Heart Association"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/JAHA.117.007475","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,13]],"date-time":"2024-05-13T11:01:23Z","timestamp":1715598083000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/JAHA.117.007475"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,3,6]]},"references-count":17,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2018,3,6]]}},"alternative-id":["10.1161\/JAHA.117.007475"],"URL":"https:\/\/doi.org\/10.1161\/jaha.117.007475","relation":{},"ISSN":["2047-9980"],"issn-type":[{"value":"2047-9980","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,3,6]]},"assertion":[{"value":"2017-08-23","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2017-12-20","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2018-02-23","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e007475"}}