Decreasing systolic blood pressure was not associated with a higher risk of cardiovascular death or heart failure hospitalization when HF medication doses were increased (HR 0.94; 95% CI 0.86-1.02).
Cohort (n=42,040)
Yes
Does optimizing or increasing heart failure medication doses modify the risk of cardiovascular death or heart failure hospitalization associated with low or decreasing systolic blood pressure in patients with HFrEF?
Low or declining systolic blood pressure should not limit heart failure medication optimization, as the associated risk of adverse outcomes is attenuated when medication doses are increased.
Effect estimate: HR 0.94 (95% CI 0.86-1.02)
AIMS: Heart failure (HF) medication may reduce blood pressure (BP). Low BP is associated with worse outcomes but how this association is modified by HF medication has not been studied. We evaluated the association between BP and outcomes according to HF medication dose in HF with reduced ejection fraction (HFrEF). METHODS AND RESULTS: We studied HFrEF patients from the Swedish HF registry (2000-2018). Associations between systolic BP (SBP) and cardiovascular death (CVD) and/or HF hospitalization (HFH) were analysed according to doses of renin-angiotensin system (RAS) inhibitors, beta-blockers and mineralocorticoid receptor antagonists (MRA). Among 42 040 patients (median age 74.0), lower baseline SBP was associated with higher risk of CVD/HFH (adjusted hazard ratio HR per 10 mmHg higher SBP: 0.92, 95% confidence interval CI 0.92-0.93), which was less high risk under optimized RAS inhibitor and beta-blocker doses (10% decrease in event rates per 10 mmHg SBP increase in untreated patients vs. 7% decrease in patients at maximum dose, both adjusted p 10 mmHg when HF medication doses were increased, whereas 24.6% reported a SBP decrease >10 mmHg with stable/decreasing doses. Decreasing SBP was associated with higher risk of CVD/HFH in patients with stable (HR 1.10, 95% CI 1.04-1.17) or decreasing (HR 1.29, 95% CI 1.18-1.42) HF medication dose but not in patients with an increase in doses (HR 0.94, 95% CI 0.86-1.02). CONCLUSIONS: The association of lower SBP with higher risk of CVD/HFH is attenuated in patients with optimized HF medication. These results suggest that low or declining SBP should not limit HF medication optimization.
Girerd et al. (Thu,) conducted a cohort in Heart failure with reduced ejection fraction (HFrEF) (n=42,040). Heart failure medication optimization (RAS inhibitors, beta-blockers, MRA) vs. Stable or decreasing doses was evaluated on Cardiovascular death and/or HF hospitalization associated with decreasing SBP (HR 0.94, 95% CI 0.86-1.02). Decreasing systolic blood pressure was not associated with a higher risk of cardiovascular death or heart failure hospitalization when HF medication doses were increased (HR 0.94; 95% CI 0.86-1.02).