Journal of cardiology · 2026
Guideline-directed medical therapy and hypotension after initiation of vericiguat: Insights from the VERIFY-HF study.
СтатьяНаблюдательное исследованиеМногоцентровое исследованиеПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод пока не подготовлен
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Kanaoka Koshiro, Nakoji Takashi, Takegawa Koki, Ishihara Satomi, Nasu Takahito, Fujimoto Wataru, Kagiyama Nobuyuki, Shiraishi Yasuyuki, Ishii Shunsuke, Ijichi Takeshi, Nakazawa Gaku, Iwanaga Yoshitaka, Hikoso Shungo, Miyamoto Yoshihiro, Matsumoto Shingo
Аннотация
BACKGROUND: Guidelines recommend vericiguat initiation in patients with heart failure (HF) with reduced ejection fraction who have already been prescribed guideline-directed medical therapy (GDMT). However, few studies have examined the safety and tolerability of vericiguat according to baseline GDMT in clinical practice.
METHODS: This retrospective observational study used data from a multicenter registry of patients who initiated vericiguat between June 2021 and September 2023. Patients with left ventricular ejection fraction <45% who had at least one GDMT at baseline were divided into two groups according to the number of GDMTs: the quadruple GDMT and non-quadruple GDMT groups. The association between baseline GDMT and hypotension and drug discontinuation within 90 days after vericiguat initiation was analyzed.
RESULTS: Among 791 patients included, 398 (50.3%), 220 (27.8%), 127 (16.1%), and 46 (5.8%) patients were prescribed quadruple, triple, double, and single GDMTs, respectively. The median (interquartile range) baseline systolic blood pressure was similar between the non-quadruple GDMT [104 (92-118) mmHg] and the quadruple GDMT [102 (90-115) mmHg] groups (p = 0.11). Patients in the non-quadruple GDMT group were older, had a lower proportion of a history of HF hospitalization, and higher B-type natriuretic peptide levels. Hypotension occurred in 28.2% in the non-quadruple GDMT group and 22.4% in the quadruple GDMT group (p = 0.057), and the adjusted odds ratio for hypotension was not different between groups (odds ratio 1.16, 95% confidence interval 0.80-1.67; p = 0.43). Drug discontinuation occurred more frequently in the non-quadruple GDMT group than in the quadruple GDMT group (16.5% vs 10.3%, p = 0.01), with hypotension accounting for a minority of discontinuations.
CONCLUSIONS: Baseline non-quadruple GDMT was not associated with hypotension after vericiguat initiation, suggesting that vericiguat may be safely added even when quadruple GDMT has not been achieved.
METHODS: This retrospective observational study used data from a multicenter registry of patients who initiated vericiguat between June 2021 and September 2023. Patients with left ventricular ejection fraction <45% who had at least one GDMT at baseline were divided into two groups according to the number of GDMTs: the quadruple GDMT and non-quadruple GDMT groups. The association between baseline GDMT and hypotension and drug discontinuation within 90 days after vericiguat initiation was analyzed.
RESULTS: Among 791 patients included, 398 (50.3%), 220 (27.8%), 127 (16.1%), and 46 (5.8%) patients were prescribed quadruple, triple, double, and single GDMTs, respectively. The median (interquartile range) baseline systolic blood pressure was similar between the non-quadruple GDMT [104 (92-118) mmHg] and the quadruple GDMT [102 (90-115) mmHg] groups (p = 0.11). Patients in the non-quadruple GDMT group were older, had a lower proportion of a history of HF hospitalization, and higher B-type natriuretic peptide levels. Hypotension occurred in 28.2% in the non-quadruple GDMT group and 22.4% in the quadruple GDMT group (p = 0.057), and the adjusted odds ratio for hypotension was not different between groups (odds ratio 1.16, 95% confidence interval 0.80-1.67; p = 0.43). Drug discontinuation occurred more frequently in the non-quadruple GDMT group than in the quadruple GDMT group (16.5% vs 10.3%, p = 0.01), with hypotension accounting for a minority of discontinuations.
CONCLUSIONS: Baseline non-quadruple GDMT was not associated with hypotension after vericiguat initiation, suggesting that vericiguat may be safely added even when quadruple GDMT has not been achieved.