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Heart failure with preserved ejection fraction and a systolic blood pressure target of 129 mmHg: are we on cloud nine?

Hypertension Research volume 48, pages 3324–3325 (2025)Cite this article

Treatment targets for systolic blood pressure (BP) represent an area of debate across different guideline recommendations for hypertension or elevated BP [1,2,3]. In the context of heart failure with preserved ejection fraction (HFpEF), a systolic BP of less than 130 mmHg has been suggested as a reasonable treatment target to pursue [1,2,3]. The present meta-analysis by Matsumoto and coworkers [4] aims to provide evidence-based support for the current guideline recommendations [1,2,3]. However, some points need to be further discussed.

First, curiously, the primary outcome was all-cause mortality and not heart failure hospitalization, which is the most expected outcome in heart failure trials. Indeed, in many heart failure trials, the co-primary outcomes are heart failure hospitalization, cardiovascular mortality, or their composite. Selecting all-cause mortality as the primary outcome in this meta-analysis contradicts the primary outcome of the selected studies, which were powered to demonstrate a difference in cardiovascular outcomes, including heart failure hospitalizations, and not for all-cause mortality. A second point is the selection of trials beginning from 2012, where a clear definition of HFpEF was developed [5]. However, the studies of the meta-analysis included patients with an ejection fraction below 50% and many of them recruited patients well before 2012 (e.g., SPRINT, November 2010; TOPCAT, August 2006). Also, the definition of HFpEF in most of the selected studies is by far different compared to the 2012 European Society of Cardiology (ESC) definition [5]. In the sub-analysis of the SPRINT, the absence of the achieved BP cannot definitively reassure that a target of <130 mmHg was achieved by those randomized to a more intensive BP target or that those randomized to less intense treatment had a systolic BP above 130 mmHg, because the number of available participants was quite limited.

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  1. Department of Cardiology, Laiko University Hospital of Athens, Athens, Greece

    Ioannis Vasileiadis, Rafaella Paparidou, Andreas Papalysandrou, Aliki Zografou, Ilektra Oikonomopoulou, Elias Sanidas & Costas Thomopoulos

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  1. Ioannis Vasileiadis
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  2. Rafaella Paparidou
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Correspondence to Costas Thomopoulos.

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Vasileiadis, I., Paparidou, R., Papalysandrou, A. et al. Heart failure with preserved ejection fraction and a systolic blood pressure target of 129 mmHg: are we on cloud nine?. Hypertens Res 48, 3324–3325 (2025). https://doi.org/10.1038/s41440-025-02409-3

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