In heart failure patients with systolic blood pressure <100 mm Hg, the use of renin-angiotensin-system inhibitors was associated with a significant survival benefit (HR 0.49; 95% CI 0.29-0.83).
Cohort (n=1,206)
Does guideline-directed medical therapy (RASi and beta-blockers) improve all-cause mortality in heart failure patients with systolic blood pressure <100 mm Hg?
In heart failure patients with systolic blood pressure <100 mmHg, renin-angiotensin-system inhibitors are associated with a significant survival benefit, whereas beta-blockers appear prognostically neutral.
Hazard Ratio: 0.49 (95% CI 0.29–0.83)
BACKGROUND: Patients with hypotension have consistently been excluded from heart failure (HF) randomized controlled trials. AIMS: We aimed to study HF patients with hypotension. METHODS: Retrospective study of outpatients with HF with left ventricular systolic dysfunction followed from January 2012-December 2020. We defined hypotension as systolic blood pressure (SBP) <100 mm Hg. ENDPOINT: all-cause mortality. Patients were followed until January 2023. A Cox-regression analysis was used to study the prognostic impact of guideline-directed medical therapy separately in HF patients with SBP <100 mm Hg and those ≥ 100 mm Hg. Adjustments were made for confounders. RESULTS: We studied 1206 HF patients, mean age 71 years; 91.4% were on β-blockers (BB), 82.8% were on renin-angiotensin-system inhibitors (RASi); 29.6% on mineralocorticoid receptor antagonists. SBP was<100 mm Hg in 157 (13.0%) patients. Hypotensive patients more often presented atrial fibrillation and severe left ventricular systolic dysfunction; they had lower hemoglobin and higher B-type natriuretic peptide; they were less medicated with RASi, but more with mineralocorticoid receptor antagonists and diuretics. BB was similarly prescribed in both groups. During a median follow-up of 47 (27-85) months, 645 (53.5%) patients died, 61.1 vs. 52.3% in hypotensive and non-hypotensive, P = 0.04. RASi prescription is associated with survival-benefit in both hypotensive (hazard ratio HR, 0.49 0.29-0.83) and non-hypotensive (HR, 0.64 0.50-0.80). BB predicted better survival in non-hypotensive (HR, 0.61 0.46-0.81), but not in hypotensive patients. CONCLUSIONS: Hypotension was associated with poor prognosis in HF patients. In patients with SBP <100 mm Hg BB use was prognostic neutral, however RASi use portended survival benefit. Despite their exclusion from most HF therapy trials, hypotensive patients appear to benefit from RASi drugs.
Fonseca et al. (Tue,) conducted a cohort in Heart failure with left ventricular systolic dysfunction (n=1,206). Renin-angiotensin-system inhibitors (RASi) vs. No RASi was evaluated on all-cause mortality (HR 0.49, 95% CI 0.29-0.83). In heart failure patients with systolic blood pressure <100 mm Hg, the use of renin-angiotensin-system inhibitors was associated with a significant survival benefit (HR 0.49; 95% CI 0.29-0.83).