Key result
In-hospital intensification of pharmacologic blood pressure-lowering therapy, quantified by the change in Therapeutic Intensity Score, was independently associated with a reduction in NT-proBNP (β = 0.384) in patients with acutely decompensated heart failure.
Why the study?
The study sought to investigate the correlation between in-hospital intensity of pharmacologic blood pressure-lowering therapy and improvement in cardiac function in patients with ADCHF and essential hypertension.
Does in-hospital intensification of pharmacologic blood pressure-lowering therapy reduce NT-proBNP in patients with acutely decompensated chronic heart failure and hypertension?
Cohort (n=517)
No
Does in-hospital intensification of pharmacologic blood pressure-lowering therapy reduce NT-proBNP in patients with acutely decompensated chronic heart failure and hypertension?
Effect estimate: β = 0.384 (95% CI 0.108-0.660)
p-value: p=0.007
In-hospital intensification of blood pressure-lowering therapy in patients with acutely decompensated heart failure and hypertension is associated with acute reductions in NT-proBNP, suggesting a benefit in reducing cardiac load.
Intensity of BP-lowering therapy may associate with cardiac improvement in ADCHF; leaves open whether this informs practice pending prospective trials.
OBJECTIVE: This study aimed to investigate the correlation between the in-hospital intensity of pharmacologic blood pressure–lowering therapy and improvement in cardiac function in patients with acutely decompensated chronic heart failure (ADCHF) and essential hypertension. METHODS: A single-center retrospective cohort study was conducted. We enrolled 517 inpatients: 257 in HF group (ADCHF with hypertension) and 260 served as controls (hypertension with normal cardiac function). The primary exposure was the change in Therapeutic Intensity Score (ΔTIS) from admission to discharge, calculated by summing the prescribed-to-maximum dose ratios of all medications with blood pressure–lowering effects. The primary outcome was the change in N-terminal pro-B-type natriuretic peptide (ΔNT-proBNP). Subgroup analyses were performed by left ventricular ejection fraction (LVEF) categories and hypertension characteristics. Associations were assessed using Spearman correlation and multivariable linear regression, adjusting for key clinical covariates. RESULTS: At admission, the HF group had a lower median TIS than controls (0.50 vs. 0.75, p < 0.001), indicating a potential gap in baseline management. During hospitalization, TIS increased significantly within the HF cohort. This treatment intensification (ΔTIS) showed a positive and independent correlation with the reduction in NT-proBNP (ΔNT-proBNP) (β = 0.384, 95% CI 0.108–0.660, p = 0.007), adjusting for age, LVEF, and other covariates. The association was consistent across heart failure phenotypes defined by LVEF. Furthermore, patients with heart failure with preserved ejection fraction (HFpEF) required a higher discharge TIS than controls with similar LVEF (1.125 vs. 0.750, p < 0.001). CONCLUSION: In patients with ADCHF and hypertension, in-hospital intensification of pharmacologic pressure-lowering therapy, quantified by ΔTIS, is associated with acute improvement in cardiac load, as reflected by NT-proBNP reduction. The TIS provides a standardized metric to quantify this treatment escalation, highlighting its potential utility for structured management. Prospective studies are warranted to determine if TIS-guided therapy improves long-term clinical outcomes.
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Zhang et al. (2026) conducted a cohort in Acutely decompensated chronic heart failure (ADCHF) and essential hypertension (n=517). In-hospital intensification of pharmacologic blood pressure-lowering therapy (ΔTIS) vs. Lower treatment intensification or controls with normal cardiac function was evaluated on Change in N-terminal pro-B-type natriuretic peptide (ΔNT-proBNP) (β = 0.384, 95% CI 0.108-0.660, p=0.007). In-hospital intensification of pharmacologic blood pressure-lowering therapy, quantified by the change in Therapeutic Intensity Score, was independently associated with a reduction in NT-proBNP (β = 0.384) in patients with acutely decompensated heart failure.
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