Key result
SGLT2 inhibitors linked to fewer major events in high-risk hypertensive-diabetic HFpEF phenotypes 1 and 2.
Why the study?
Due to the heterogeneous mechanisms and multimorbidity of HFpEF, the study aimed to identify phenotypes of hypertensive-diabetic HFpEF, their related outcomes, and treatment responses.
Does treatment response to SGLT2 inhibitors, RAAS inhibitors, and beta blockers vary by clinical phenotype in patients with HFpEF and comorbid hypertension and diabetes?
Cohort (n=233)
Yes
Does treatment response to SGLT2 inhibitors, RAAS inhibitors, and beta blockers vary by clinical phenotype in patients with HFpEF and comorbid hypertension and diabetes?
p-value: p=0.002
Different phenotypes of hypertensive-diabetic HFpEF exhibit distinct clinical outcomes and differential responses to heart failure therapies, supporting a personalized management approach.
May support phenotype-guided SGLT2i use in higher-risk hypertensive-diabetic HFpEF; hypothesis-generating pending randomized validation.
Despite evidence of SGLT2 inhibitors in improving cardiovascular outcomes of heart failure with preserved ejection fraction (HFpEF), the heterogenous mechanism and characteristic multimorbidity of HFpEF require a phenotypic approach. Metabolic phenotype, one common HFpEF phenotype, has various presentations and prognoses worldwide. We aimed to identify different phenotypes of hypertensive-diabetic HFpEF, their phenotype-related outcomes, and treatment responses. The primary endpoint was time to the first event of all-cause mortality or hospitalization for heart failure (HHF). Among 233 recruited patients, 24.9% experienced primary outcomes within 12 months. A total of 3.9% was lost to follow-up. Three phenotypes were identified. Phenotype 1 (n = 126) consisted of lean, elderly females with chronic kidney disease, anemia, and concentric hypertrophy. Phenotype 2 (n = 62) included younger males with coronary artery disease. Phenotype 3 (n = 45) comprised of obese elderly with atrial fibrillation. Phenotype 1 and 2 reported higher primary outcomes than phenotype 3 (p = 0.002). Regarding treatment responses, SGLT2 inhibitor was associated with fewer primary endpoints in phenotype 1 (p = 0.003) and 2 (p = 0.001). RAAS inhibitor was associated with fewer all-cause mortality in phenotype 1 (p = 0.003). Beta blocker was associated with fewer all-cause mortality in phenotype 1 (p = 0.024) and fewer HHF in phenotype 2 (p = 0.011). Our pioneering study supports the personalized approach to optimize HFpEF management in hypertensive-diabetic patients.
No takes yet. Share an insight, caveat, or question.
Nguyen et al. (2023) conducted a cohort in Heart failure with preserved ejection fraction with comorbid hypertension and diabetes (n=233). SGLT2 inhibitors, RAAS inhibitors, and Beta blockers was evaluated on Time to the first event of all-cause mortality or hospitalization for heart failure (HHF) (p=0.002). In hypertensive-diabetic HFpEF, phenotypes 1 and 2 had higher rates of mortality or heart failure hospitalization than phenotype 3 (p=0.002), with SGLT2 inhibitors improving outcomes in phenotypes 1 and 2.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: