Key result
GDMT in HF lowers SBP by a negligible ~2 mmHg with similar cardiovascular benefits.
Why the study?
Patients with heart failure often have restricted access to guideline-directed medical therapy when blood pressure is low, though some medications show benefit with minimal blood pressure impact. Whether this applies across all guideline-directed medical therapies remained unclear.
Does guideline-directed medical therapy provide cardiovascular benefits and affect systolic blood pressure safely in heart failure patients with low baseline blood pressure?
Meta-Analysis (n=84,782)
Does guideline-directed medical therapy provide cardiovascular benefits and affect systolic blood pressure safely in heart failure patients with low baseline blood pressure?
Effect estimate: WMD -2.16 (95% CI -2.86 to -1.46)
GDMT provides similar cardiovascular benefits without significantly increasing the risk of hypotension in heart failure patients with low baseline systolic blood pressure, supporting its initiation and maintenance in this population.
Supports initiating and maintaining GDMT in heart failure patients with low baseline blood pressure;.
AIMS: Existing research indicates that patients with heart failure (HF) may have restricted access to guideline-directed medical therapy (GDMT) when their blood pressure (BP) is comparatively low. However, recent clinical trials suggest that HF patients with low BP could still benefit from certain HF medications, which have a minimal impact on BP. This systematic review and meta-analysis was conducted to determine whether this applies to all GDMT. METHODS AND RESULTS: A systematic search of MEDLINE and EMBASE was conducted for studies published from inception to 10 January 2024. Randomized controlled trials were selected if they reported on the longitudinal change of systolic BP (SBP) due to GDMT, or the risks of cardiovascular events in HF patients based on SBP categories. Weighted mean difference (WMD), hazard ratio or relative risk, and corresponding 95% confidence intervals (CI) were pooled for meta-analysis where possible. Data from 20 studies, encompassing information on 84 782 individuals, were analysed. Overall, GDMT is associated with lower SBP (WMD, -2.16; 95% CI -2.86 to -1.46), with no significant difference between baseline low and non-low BP subgroups (interaction p = 0.810). However, SBP of the treatment group increased by 5.8 mmHg from baseline in the low SBP subgroup during follow-up, while it decreased by 4.0 mmHg in the baseline non-low SBP subgroup. GDMT demonstrated similar cardiovascular benefits and risk of hypotension between low and non-low SBP subgroups (interaction p = 0.318 and 0.903, respectively). CONCLUSIONS: Guideline-directed medical therapy is associated with a negligible decrease in SBP, but can provide similar cardiovascular benefits in both low and non-low SBP HF patients, with no significant interaction with SBP as to hypotension. Therefore, GDMT should be initiated and maintained in HF patients with low BP.
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Li et al. (2024) conducted a meta-analysis in Heart failure (n=84,782). Guideline-directed medical therapy (GDMT) was evaluated on Longitudinal change of systolic BP (SBP) (WMD -2.16, 95% CI -2.86 to -1.46). Guideline-directed medical therapy in heart failure patients was associated with a negligible decrease in systolic blood pressure (WMD -2.16; 95% CI -2.86 to -1.46) and similar cardiovascular benefits.
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