Identification and prognosis of low office and ambulatory blood pressure in patients with heart failure.

BACKGROUND

Low blood pressure (BP) limits the up-titration of guideline-directed medical therapies (GDMTs) and predicts poor outcomes in heart failure (HF). We assessed the value of ambulatory BP monitoring (ABPM) in detecting low BP and its impact on GDMTs optimization and prognosis in HF.

METHODS

In 491 HF patients initiating GDMTs from the Risk Evaluation and Management in Heart Failure (REM-HF) study since April 2018 to December 2022, ABPM was measured in addition to office BP. Participants were classified as sustained low systolic BP (SBP) (24-hour and office SBP < 120 mmHg), masked low SBP (24-hour SBP < 120 mmHg, office SBP ≥ 120 mmHg), and no low SBP. The primary outcome was a composite of all-cause mortality and HF rehospitalization. GDMTs target dose achievement was assessed at 3 months. Logistic regression and Cox regression models were used to assess GDMTs optimization and outcomes across SBP groups.

RESULTS

Sustained, masked, and no low SBP were observed in 25.3%, 30.8%, and 44.0% of patients, respectively. Both sustained (OR 2.36, 95%CI 1.25-4.47) and masked low SBP (OR 2.32, 95%CI 1.11-4.87) groups were associated with lower likelihood of achieving GDMTs target doses. Over a median 21-month follow-up, all-cause mortality and HF rehospitalization rates were higher in sustained (HR 2.45, 95% CI 1.56-3.86) and masked low SBP (HR 1.68, 95% CI 1.08-2.62) groups. No difference was found in the target dose achievement and outcomes between the two low SBP groups.

CONCLUSION

Sustained and masked low SBP were common in HF and both associated with GDMTs intolerance and adverse outcomes.