Kardiologia polska · 2026
Prognostic impact of heart failure guideline-directed medical therapy in patients with low blood pressure.
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Fonseca Ana Margarida, Grijó Carlos, Costa Adriana, Reis Catarina, Ribeiro Rui, Correia Francisca, Toste Ana, Guimarães Carolina, Gouveia Rita, Elias Catarina, Matos Inês, Carreira Marta, Pereira Joana, Almeida Jorge, Lourenço Patrícia
Аннотация
BACKGROUND: Patients with hypotension have consistently been excluded from heart failure (HF)randomized controlled trials.
AIMS: We aimed to study HF patients with hypotension.
METHODS: A retrospective study of HF outpatients with left ventricular systolic dysfunction, followedfrom January 2012 to December 2020. We defined hypotension as systolic blood pressure(SBP) <100 mm Hg. The endpoint was all-cause mortality or heart transplantation. Patients werefollowed until January 2023. A Cox-regression analysis was used to study the prognostic impact ofguideline-directed medical therapy separately in HF patients with SBP <100 mm Hg and those withSBP ≥100 mm Hg. Adjustments were made for confounders.
RESULTS: We studied 1206 HF patients, mean age 71 years, of whom 91.4% were on β-blockers(BBs), 82.8% were on renin-angiotensin-system inhibitors (RASi), and 29.6% on mineralocorticoidreceptor antagonists. SBP was <100 mm Hg in 157 (13.0%) patients. Hypotensive patients moreoften presented with atrial fibrillation and severe left ventricular systolic dysfunction. They hadlower hemoglobin and higher B-type natriuretic peptide levels, and were less medicated with RASi,but more with mineralocorticoid receptor antagonists and diuretics. BBs were similarly prescribedin both groups. During a median follow-up of 47 (27-85) months, 645 (53.5%) patients died, 61.1%vs. 52.3% in hypotensive and non-hypotensive groups, respectively (P = 0.04). RASi prescriptionis associated with survival-benefit in both hypotensive (hazard ratio [HR], 0.49; 95% confidenceinterval [CI], 0.29-0.83) and non-hypotensive (HR, 0.64; 95% CI, 0.50-0.80) patients. BBs predictedbetter survival in non-hypotensive (HR, 0.61; 95% CI, 0.46-0.81), but not in hypotensive patients.
CONCLUSIONS: Hypotension was associated with poor prognosis in HF patients. In patients withSBP <100 mm Hg, the BB use had no prognostic impact, however, the RASi use implied a survivalbenefit. Despite their exclusion from most HF therapy trials, hypotensive patients appear to benefitfrom RASi drugs.
AIMS: We aimed to study HF patients with hypotension.
METHODS: A retrospective study of HF outpatients with left ventricular systolic dysfunction, followedfrom January 2012 to December 2020. We defined hypotension as systolic blood pressure(SBP) <100 mm Hg. The endpoint was all-cause mortality or heart transplantation. Patients werefollowed until January 2023. A Cox-regression analysis was used to study the prognostic impact ofguideline-directed medical therapy separately in HF patients with SBP <100 mm Hg and those withSBP ≥100 mm Hg. Adjustments were made for confounders.
RESULTS: We studied 1206 HF patients, mean age 71 years, of whom 91.4% were on β-blockers(BBs), 82.8% were on renin-angiotensin-system inhibitors (RASi), and 29.6% on mineralocorticoidreceptor antagonists. SBP was <100 mm Hg in 157 (13.0%) patients. Hypotensive patients moreoften presented with atrial fibrillation and severe left ventricular systolic dysfunction. They hadlower hemoglobin and higher B-type natriuretic peptide levels, and were less medicated with RASi,but more with mineralocorticoid receptor antagonists and diuretics. BBs were similarly prescribedin both groups. During a median follow-up of 47 (27-85) months, 645 (53.5%) patients died, 61.1%vs. 52.3% in hypotensive and non-hypotensive groups, respectively (P = 0.04). RASi prescriptionis associated with survival-benefit in both hypotensive (hazard ratio [HR], 0.49; 95% confidenceinterval [CI], 0.29-0.83) and non-hypotensive (HR, 0.64; 95% CI, 0.50-0.80) patients. BBs predictedbetter survival in non-hypotensive (HR, 0.61; 95% CI, 0.46-0.81), but not in hypotensive patients.
CONCLUSIONS: Hypotension was associated with poor prognosis in HF patients. In patients withSBP <100 mm Hg, the BB use had no prognostic impact, however, the RASi use implied a survivalbenefit. Despite their exclusion from most HF therapy trials, hypotensive patients appear to benefitfrom RASi drugs.