Background: Hypertension is a major risk factor for several cardiovascular diseases including heart failure, atrial fibrillation, coronary heart disease, stroke, and all-cause mortality. Several studies have investigated the association between hypertension and risk of heart failure, but not all the studies have shown an increased risk and studies and differed with regard to the strength of the observed association. The objective of this systematic review and meta-analysis was to summarize the available data from cohort studies on the association between hypertension, systolic and diastolic blood pressure and the risk of heart failure.Methods: PubMed and Embase databases were searched for relevant articles from inception up to May 2020. Cohort studies on hypertension or blood pressure causing heart failure were included. Random effect models were used to calculate summary relative risks (RRs) and 95% confidence intervals (CIs) for the association between hypertension or blood pressure and heart failure risk.
Results: A total of 36 cohort studies were included in the meta-analysis. The summary RR was 1.67 (95% Cl: 1.46-1.90, I2 =92.8%, Pheterogeneity < 0.0001) for hypertension vs.no hypertension (n=23 studies, 20233 cases, 643694 participants ), 1.31 (95% CI: 1.20-1.44, I2 = 94.6%, Pheterogeneity = 0.0001) per 20 mmHg of systolic blood pressure (13 studies, 22159 cases, 2159707 participants) and 1.14 (95% CI: 1.01-1.30, I2 = 96.7%, Pheterogeneity= 0.0001) per 10 mmHg of diastolic blood pressure (6 studies, 14024 cases and 284177 participants). There was evidence of nonlinear association between SBP and DBP and heart failure with a steeper increase in the risk at higher levels. There was no indication of publication bias and the association between hypertension and heart failure persisted across all subgroup analyses.
Conclusion: The findings of this meta-analysis suggest a strong positive association between hypertension and systolic and diastolic blood pressure and the risk of heart failure. Any further studies should clarify the shape of the dose-response relationship between blood pressure and heart failure.