BACKGROUND Guidelines recommend targeting systolic blood pressure (SBP) <130 mm Hg in heart failure with preserved ejection fraction (HFpEF) with limited data. OBJECTIVES This study sought to determine the optimal achieved SBP and whether the treatment effects of sacubitril/valsartan on outcomes are related to BP lowering, particularly among women who derive greater benefit from sacubitril/valsartan. METHODS Using 4,795 trial participants, this study related baseline and time-updated mean achieved SBP quartiles (<120, 120 to 129, 130 to 139, ≥140 mm Hg) to the primary outcome (cardiovascular death and total heart failure hospitalization), its components, myocardial infarction or stroke, and a renal composite outcome. At the 16-week visit, the study assessed the relationship between SBP change and Kansas City Cardiomyopathy Questionnaire overall summary score (KCCQ-OSS) and N-terminal pro-B-type natriuretic peptide (NT-proBNP). The study analyzed whether the BP-lowering effects of sacubitril/valsartan accounted for its treatment effects. RESULTS Average age was 73 ± 8 years, and 52% of participants were women. After multivariable adjustment, baseline and mean achieved SBP of 120 to 129 mm Hg demonstrated the lowest risk for all outcomes. Sacubitril/valsartan reduced SBP by 5.2 mm Hg (95% confidence interval: 4.4 to 6.0) compared with valsartan at 4 weeks, which was not modified by baseline SBP. However, sacubitril/valsartan reduced SBP more in women (6.3 mm Hg) than men (4.0 mm Hg) (interaction p = 0.005). Change in SBP was directly associated with change in NT-proBNP (p < 0.001) but not KCCQ-OSS (p = 0.40). The association between sacubitril/valsartan and the primary outcome was not modified by baseline SBP (interaction p = 0.50) and was similar when adjusting for time-updated SBP, regardless of sex. CONCLUSIONS Baseline and mean achieved SBP of 120 to 129 mm Hg identified the lowest risk patients with HFpEF. Baseline SBP did not modify the treatment effect of sacubitril/valsartan, and the BP-lowering effects of sacubitril/valsartan did not account for its effects on outcomes, regardless of sex. (Prospective Comparison of ARNI With ARB Global Outcomes in HF With Preserved Ejection Fraction [PARAGON-HF]; NCT01920711).

中文翻译：

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用沙库巴曲/缬沙坦治疗保留射血分数的心力衰竭的收缩压

背景指南建议在有限数据的情况下，将保留射血分数的心力衰竭 (HFpEF) 的收缩压 (SBP) 设为 <130 mm Hg。目的 本研究旨在确定最佳达到的 SBP 以及沙库巴曲/缬沙坦对结局的治疗效果是否与血压降低有关，特别是在从沙库巴曲/缬沙坦获得更大益处的女性中。方法 使用 4,795 名试验参与者，本研究将基线和时间更新的平均 SBP 四分位数（<120、120 至 129、130 至 139、≥140 mm Hg）与主要结局（心血管死亡和总心力衰竭住院）、其成分、心肌梗塞或中风以及肾脏复合结局。在为期 16 周的访问中，001) 但不是 KCCQ-OSS (p = 0.40)。沙库巴曲/缬沙坦与主要结局之间的相关性未因基线 SBP（相互作用 p = 0.50）而改变，并且在调整时间更新的 SBP 时相似，无论性别如何。结论 基线和平均 SBP 为 120 至 129 mm Hg 确定了 HFpEF 风险最低的患者。基线 SBP 并未改变沙库巴曲/缬沙坦的治疗效果，并且沙库巴曲/缬沙坦的降压作用并未解释其对结果的影响，无论性别如何。（ARNI 与 ARB 在射血分数保留的 HF 中的全球结果的前瞻性比较 [PARAGON-HF]；NCT01920711）。50）并且在调整时间更新的 SBP 时相似，无论性别如何。结论 基线和平均 SBP 为 120 至 129 mm Hg 确定了 HFpEF 风险最低的患者。基线 SBP 并未改变沙库巴曲/缬沙坦的治疗效果，并且沙库巴曲/缬沙坦的降压作用并未解释其对结果的影响，无论性别如何。（ARNI 与 ARB 在射血分数保留的 HF 中的全球结果的前瞻性比较 [PARAGON-HF]；NCT01920711）。50）并且在调整时间更新的 SBP 时相似，无论性别如何。结论 基线和平均 SBP 为 120 至 129 mm Hg 确定了 HFpEF 风险最低的患者。基线 SBP 并未改变沙库巴曲/缬沙坦的治疗效果，并且沙库巴曲/缬沙坦的降压作用并未解释其对结果的影响，无论性别如何。（ARNI 与 ARB 在射血分数保留的 HF 中的全球结果的前瞻性比较 [PARAGON-HF]；NCT01920711）。