Effect of baseline and changes in systolic blood pressure over time on the effectiveness of valsartan in the Valsartan Heart Failure Trial.

BACKGROUND: Low systolic blood pressure (SBP) is a risk factor for adverse outcomes in patients with heart failure (HF). Valsartan improved morbidity rates in the Valsartan Heart Failure Trial (Val-HeFT) despite a reduction in SBP. The aim of the present study was to investigate the relationship between the SBP-lowering effects of valsartan and its cardiovascular protective effects in this population.

METHODS AND RESULTS: Baseline measurements and changes in SBP at 4 months were related to mortality and morbidity rates. The effects of valsartan on these end points were compared in quartiles of baseline SBP with multivariable Cox proportional hazards regression models that included a test for interaction between the effects of valsartan treatment and baseline SBP and examined the effects of changes in SBP on the valsartan effect. The mean+/-SD baseline SBP in all patients (n=5010) was 124+/-18 mm Hg. Patients in the lowest quartile of SBP (SBP
CONCLUSIONS: Baseline SBP and a decrease in SBP over time were risk factors for adverse events in HF. Valsartan reduced SBP but not in the high-risk group of patients who had a baseline SBP <110 mm Hg. The beneficial effects of valsartan did not vary significantly with baseline SBP, and decreases in SBP did not counteract the beneficial effects on HF morbidity rates.