Abstract: TH-PO201
Is the Increased Risk of Heart Failure with Preserved Ejection Fraction (HFpEF) and Heart Failure with Reduced Ejection Fraction (HFrEF) in CKD in Type 2 Diabetes (T2D) explained by Hypertension (HTN)?
Session Information
- Hypertension and CVD: Clinical - I
November 02, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Hypertension and CVD
- 1602 Hypertension and CVD: Clinical
Authors
- Hartsell, Sydney Elizabeth, VA Salt Lake City Health Care System, Salt Lake City, Utah, United States
- Sarwal, Amara, VA Salt Lake City Health Care System, Salt Lake City, Utah, United States
- Wei, Guo, VA Salt Lake City Health Care System, Salt Lake City, Utah, United States
- Nevers, Mckenna R., VA Salt Lake City Health Care System, Salt Lake City, Utah, United States
- Adams, Brad, VA Salt Lake City Health Care System, Salt Lake City, Utah, United States
- Singh, Ravinder, VA Salt Lake City Health Care System, Salt Lake City, Utah, United States
- Boucher, Robert E., VA Salt Lake City Health Care System, Salt Lake City, Utah, United States
- Mohammed, Azeem Mohiuddin, University of Utah Health, Salt Lake City, Utah, United States
- Greene, Tom, VA Salt Lake City Health Care System, Salt Lake City, Utah, United States
- Beddhu, Srinivasan, VA Salt Lake City Health Care System, Salt Lake City, Utah, United States
Background
CKD is a clear risk factor for HFpEF and HFrEF but the degree to which HTN it plays a role in the pathogenesis of these disorders in CKD is unknown.
Methods
We used the VA Informatics and Computing Infrastructure to create a national cohort of veterans with T2D but without HF (using ICD9/10 codes) who had at least 2 outpatient CKD-EPI eGFR measured from 1/1/2000 to 12/31/2021 (n=2,462,350). Incident HF through 12/31/2021 were identified using ICD 9/10 codes. Using ejection fraction (EF) data extracted with natural language processing from echocardiograms done within 180 days of HF diagnosis, HFpEF (EF ≥ 50%) and HFpEF (< 50%) were defined. We related CKD stages at baseline with time to HFpEF or HFrEF incidence while adjusting for demographics, baseline comorbidities, BMI, duration of T2D, diabetic retinopathy, T2D meds, statins and A1C in separate Cox regression models. We then adjusted for baseline hypertension, blood pressure (BP) and BP-modulating medications.
Results
Out of 410,783 (16.7%) patients who developed HF over 1.78 million patient-years of follow up, 289,508 (70.5%) had an echocardiogram within 180 days of diagnosis (median days for the closet echo with diagnosis 1 with IQR 0 to 13). Mean EF was 45±15%. Overall, 168,079 (6.8%) patients developed HFpEF and 121,421 (4.9%) HFrEF. As shown in the Figure, adjusted for demographics, comorbidity and other factors, more advanced CKD was associated with higher risk of HFpEF and HFrEF. Adjusting for baseline hypertension, SBP and DBP and BP meds resulted in modest to moderate attenuation of the associations of CKD stages with HFpEF or HFrEF.
Conclusion
HTN appears to play a role in both HFpEF and HFrEF, particularly in CKD stages 3a and 3b to 4. Intensive BP control might reduce the risk of HFpEF and HFrEF in these stages of CKD than in stage V/ ESRD.
Funding
- Veterans Affairs Support