Key result
SGLT2 inhibitors linked to ~36% fewer major events in ADHF patients with admission SBP >105 mmHg.
Why the study?
SGLT2 inhibitors provide cardiovascular benefits in heart failure, but their effectiveness across baseline systolic blood pressure levels remains uncertain.
Does early in-hospital initiation of SGLT2 inhibitors reduce the 12-month composite of cardiovascular death or heart failure rehospitalization in adults with acute decompensated heart failure, and does admission systolic blood pressure modify this effect?
Cohort (n=219)
No
Does early in-hospital initiation of SGLT2 inhibitors reduce the 12-month composite of cardiovascular death or heart failure rehospitalization in adults with acute decompensated heart failure, and does admission systolic blood pressure modify this effect?
Absolute Event Rate: 28.6% vs 44.8%
p-value: p=0.045
In patients hospitalized for acute decompensated heart failure, early initiation of SGLT2 inhibitors is associated with improved 12-month cardiovascular outcomes primarily in those with an admission systolic blood pressure >105 mmHg.
Sodium–glucose cotransporter-2 inhibitors (SGLT2i) provide cardiovascular benefits in heart failure (HF), but their effectiveness across baseline systolic blood pressure (SBP) levels remains uncertain. This study evaluated the prognostic impact of SGLT2i in hospitalized patients with acute decompensated heart failure (ADHF), stratified by admission SBP. In this single-center retrospective cohort study, 219 adults hospitalized for ADHF between January 2020 and December 2024 were included. Patients were grouped by admission SBP into low (≤ 105 mmHg, n = 74) and high (> 105 mmHg, n = 135) categories. The primary outcome was a 12-month composite of HF rehospitalization or cardiovascular death. Secondary outcomes included changes in NT-proBNP, NYHA class, and left ventricular ejection fraction (LVEF). Cox regression and Kaplan–Meier analysis were used to assess associations with outcomes. The composite outcome occurred more frequently in the low SBP group (47.3% vs. 35.6%, P = 0.089), with a shorter median time to event (78 vs. 96 days, P = 0.048). Both groups showed LVEF and NT-proBNP improvement, but LVEF remained consistently higher in the high SBP group (P < 0.05). SGLT2i use was associated with lower event risk in the high SBP group (28.6% vs. 44.8%, P = 0.045), but no significant benefit was observed in the low SBP group (42.4% vs. 51.2%, P = 0.438). Baseline SBP may influence the clinical benefit of SGLT2i in ADHF. Patients with higher SBP may derive greater benefit. These findings underscore the potential utility of SBP-based stratification in HF management.
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Guo et al. (2026) conducted a cohort in Acute decompensated heart failure (ADHF) (n=219). SGLT2 inhibitors (dapagliflozin or empagliflozin) vs. Non-users was evaluated on 12-month composite of HF rehospitalization or cardiovascular death (in high SBP >105 mmHg group) (p=0.045). SGLT2 inhibitors reduced 12-month cardiovascular death or heart failure rehospitalization in acute decompensated heart failure patients with admission SBP >105 mmHg (28.6% vs. 44.8%, P=0.045).
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