Predictors of chronic heart failure in patients with hypertension and pre–heart failure: a cohort study

BACKGROUND: Identifying predictors of chronic heart failure is an essential preventive step in patients with pre–heart failure.

AIM: This study aimed to identify predictors of chronic heart failure development in outpatients with hypertension and pre–heart failure.

METHODS: A single-center study included 356 outpatients with hypertension and pre–heart failure. The mean age was 62.65 ± 10.59 years; 128 (36%) participants were men. The patients received drug therapy for hypertension, with treatment adjustment after 1 and 3 months and subsequently annually for 3 years. Later on, outcomes defined as the development of chronic heart failure were evaluated. Multiple binary logistic regression analysis was used to identify predictors of chronic heart failure onset.

RESULTS: Over a 3-year period (2022–2025), chronic heart failure with preserved ejection fraction developed in 8.7% of patients with hypertension and pre–heart failure. Analysis of risk factors showed that patients who developed chronic heart failure were older (66.37 ± 9.55 years; p < 0.001), had a longer duration of hypertension (17.85 ± 10.43 years; p < 0.001), higher body mass index (29.41 ± 4.85 kg/m²; p = 0.002), and a lower glomerular filtration rate (73.23 ± 18.19 mL/min/1.73 m²; p < 0.001). In this group, paroxysmal (p < 0.001) and persistent atrial fibrillation (p < 0.001), as well as type 2 diabetes mellitus (p < 0.001), were observed more frequently. In these patients, more pronounced structural and functional cardiac changes were already present at enrollment into the study, namely, indexed left atrial volume (47.93 ± 14.85 vs 33.68 ± 5.57 mL/m²; p < 0.001), indexed myocardial mass (104.18 ± 29.34 vs 92.55 ± 19.36 g/m²; p = 0.045), maximum pulmonary vein diameter (21.23 ± 2.24 vs 17.34 ± 1.64 mm; p < 0.001), and minimum pulmonary vein diameter (11.09 ± 2.42 vs 7.36 ± 1.53 mm; p < 0.001). The predictors associated with the onset of chronic heart failure after 3 years in patients with hypertension included maximum pulmonary vein diameter, left atrial volume, age, body mass index, and the presence of atrial fibrillation.

CONCLUSION: Within 3 years, chronic heart failure with preserved ejection fraction developed in 8.7% of patients with pre–heart failure. Predictors of its development in patients with hypertension included maximum pulmonary vein diameter, left atrial volume, age, body mass index, and the presence of atrial fibrillation.