A review of available evidence proposes a step-wise approach for managing symptomatic or severe persistent hypotension in ambulatory HFrEF patients to optimize pharmacological treatment.
How should low blood pressure be managed in ambulatory patients with HFrEF to optimize guideline-directed medical therapy?
This review provides expert consensus on managing hypotension in HFrEF patients to optimize the titration of guideline-directed medical therapy.
Low blood pressure is common in patients with heart failure and reduced ejection fraction (HFrEF). While spontaneous hypotension predicts risk in HFrEF, there is only limited evidence regarding the relationship between hypotension observed during heart failure (HF) drug titration and outcome. Nevertheless, hypotension (especially orthostatic hypotension) is an important factor limiting the titration of HFrEF treatments in routine practice. In patients with signs of shock and/or severe congestion, hospitalization is advised. However, in the very frequent cases of non-severe and asymptomatic hypotension observed while taking drugs with a class I indication in HFrEF, European and US guidelines recommend maintaining the same drug dosage. In instances of symptomatic or severe persistent hypotension (systolic blood pressure < 90 mmHg), it is recommended to first decrease blood pressure reducing drugs not indicated in HFrEF as well as the loop diuretic dose in the absence of associated signs of congestion. Unless the management of hypotension appears urgent, a HF specialist should then be sought rather than stopping or decreasing drugs with a class I indication in HFrEF. If symptoms or severe hypotension persist, no recommendations exist. Our HF group reviewed available evidence and proposes certain steps to follow in such situations in order to improve the pharmacological management of these patients.
Cautela et al. (Thu,) conducted a review in Heart failure with reduced ejection fraction (HFrEF) and low blood pressure. Pharmacological management of low blood pressure was evaluated. A review of available evidence proposes a step-wise approach for managing symptomatic or severe persistent hypotension in ambulatory HFrEF patients to optimize pharmacological treatment.