Diastolic blood pressure lower than 75 mmHg is associated with adverse outcomes in patients with heart failure with preserved ejection fraction induced or exacerbated by atrial fibrillation

Background The effects of diastolic blood pressure(DBP)on prognosis of heart failure with preserved ejection fraction(HFp EF)are still not clear,probably due to the underlying heterogeneity of HFp EF.This study was aimed to evaluate the effects of DBP in patients with atrial fibrillation(AF)-induced or AF-exacerbated HFp EF,which is a clinical syndrome with high homogeneity that has seldom been discussed.Methods In this retrospective cohort study,955 patients diagnosed with AF and HFp EF were screened.Patients with specific underlying cardiovascular diseases or other severe comorbidities were excluded.A total of 191 patients were included.Patients were assigned to one of the two groups:DBP<75 mm Hg or DBP≥75 mm Hg All-cause mortality was taken as primary endpoint,and all-cause re-hospitalization and HF specific re-hospitalization were measured as secondary endpoints.Results The mean follow-up was 49 months.Multiple established clinical risk factors and prognostic biomarkers for heart failure were adjusted.Patients with DBP<75 mm Hg demonstrated higher allcause mortality compared with patients with DBP of≥75 mm Hg[odds ratio(OR):1.669,95%confidence Interval(CI):1.040-2.679,P=0.034).The risk of all-cause re-hospitalization was also increased in the group with DBP<75 mm Hg(OR:1.426,95%CI:1.006-2.022,P=0.047).However,there was no statistically significant difference in the risk of re-hospitalization due to HF between the two groups(OR:1.005,95%CI:0.565-1.787,P=0.986).Conclusions In patients with AF-induced or AF-exacerbated HFp EF,DBP<75 mm Hg was associated with higher all-cause mortality and all-cause re-hospitalization,but was not associated with re-hospitalization due to HF.