Arterial Hypertension in Patients with Takotsubo Syndrome: Prevalence, Long-Term Outcome, and Secondary Preventive Strategies. A Report from the Takotsubo Italian Network Register.

The aim of this study was to investigate the long-term outcome of takotsubo syndrome (TTS) patients with and without hypertension (HT), and to evaluate the effectiveness of treatment with beta-blockers (BB) and/or renin-angiotensin-aldosterone system inhibitors (RAASi). The study population includes a register-based, multicenter cohort of consecutive patients with TTS, divided into two groups according to the history of HT. Further stratification was performed for BB/RAASi prescription at discharge. The primary outcome was the composite of all-cause death and TTS recurrence at the longest available follow-up. The propensity score weighting technique was used to account for potential confounding.In the overall population (903 patients, mean age 70 ± 11 years), HT was reported in 66% of cases. At median 2-year follow-up, there was no difference in the risk of the primary composite outcome between patients with and without HT. The adjusted Cox regression analysis showed a significantly lower risk for the primary outcome (aHR:0.69; 95%CI:0.49-0.99) in patients who received BB vs. those who did not. RAASi treatment was not associated with the primary study outcome. The lower risk for the primary outcome with BB treatment was confirmed in patients with HT (aHR:0.37; 95%CI:0.24-0.56) but not in patients without (aHR:1.83; 95%CI:0.92-3.64; pinteraction < 0.001). In this TTS study, HT did not affect the long-term risk of adverse events but increased the probability of benefit from BB treatment after discharge. Owing to the favourable outcome impact of BB prescription in TTS patients with HT, a tailored pharmacological therapy should be considered in this cohort. Although not associated with clinical outcome, hypertension seems to modify the long-term effectiveness of pharmacological treatment in patients with takotsubo syndrome (TTS). Beta-blockers improved the overall survival of TTS patients with hypertension and should be considered as first-line therapy in this patient population. The effectiveness of renin-angiotensin-aldosterone system inhibitors on long-term outcome was not significant regardless of the history of hypertension.

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