Ivabradine reduced the composite outcome in chronic systolic heart failure across all baseline systolic blood pressure tertiles, including SBP <115 mmHg (HR 0.84; 95% CI 0.72-0.98; P interaction=0.68).
Cohort (n=6,505)
Does ivabradine reduce the composite outcome in patients with chronic systolic heart failure across different baseline systolic blood pressure levels?
Ivabradine demonstrates consistent efficacy and safety in chronic systolic heart failure regardless of baseline systolic blood pressure, supporting its use even in patients with low SBP.
Effect estimate: HR 0.84 (95% CI 0.72-0.98)
p-value: P interaction = 0.68
AIMS: Low systolic blood pressure (SBP) is associated with poor outcomes in heart failure and complicates management. In a post hoc analysis, we investigated the efficacy and safety of ivabradine in the SHIFT population divided by tertiles of baseline SBP. METHODS AND RESULTS: The analysis comprised 2110 patients with SBP <115 mmHg, 1968 with 115≤ SBP <130 mmHg, and 2427 with SBP ≥130 mmHg. Patients with low SBP were younger, had lower ejection fraction, and were less likely to be at target beta-blocker dose than patients in the other SBP groups. Ivabradine was associated with a similar relative risk reduction of the composite outcome in the three SBP groups SBP <115 mmHg, hazard ratio (HR) = 0.84, 95% confidence interval (CI) 0.72-0.98; 115≤ SBP <130 mmHg, HR = 0.86, 95% CI 0.72 to 1.03; SBP ≥130 mmHg, HR = 0.77, 95% CI 0.66 to 0.92; P interaction = 0.68. Similar results were found for cardiovascular mortality (P interaction = 0.91), hospitalization because of heart failure (P interaction = 0.79), all-cause mortality (P interaction = 0.90), and heart failure mortality (P interaction = 0.18). There was no evidence for a difference in safety profile according to SBP group. CONCLUSION: The efficacy and safety of ivabradine is independent of SBP. This may have implications for the management of HF patients with low SBP and elevated heart rate.
Komajda et al. (Tue,) conducted a cohort in Chronic Systolic Heart Failure (n=6,505). Ivabradine was evaluated on Composite outcome (HR 0.84, 95% CI 0.72-0.98, p=P interaction = 0.68). Ivabradine reduced the composite outcome in chronic systolic heart failure across all baseline systolic blood pressure tertiles, including SBP <115 mmHg (HR 0.84; 95% CI 0.72-0.98; P interaction=0.68).