PMID- 36270494
OWN - NLM
STAT- MEDLINE
DCOM- 20221216
LR  - 20230216
IS  - 1874-1754 (Electronic)
IS  - 0167-5273 (Linking)
VI  - 370
DP  - 2023 Jan 1
TI  - Low blood pressure and guideline-directed medical therapy in patients with heart 
      failure with reduced ejection fraction.
PG  - 255-262
LID - S0167-5273(22)01640-0 [pii]
LID - 10.1016/j.ijcard.2022.10.129 [doi]
AB  - BACKGROUND: Patients with heart failure (HF) presenting with low blood pressure 
      (BP) have been underrepresented in large-scale clinical trials. We investigated 
      the characteristics and implementation of conventional guideline-directed medical 
      therapy (GDMT; renin-angiotensin system inhibitors and beta-blockers) in patients 
      with low BP hospitalized for HF with systolic dysfunction. METHODS: Conventional 
      GDMT was evaluated by discharge BP among 2043 consecutive patients with HF and 
      left ventricular ejection fraction (LVEF) < 50% in the WET-HF registry. Among the 
      708 (34.7%) patients with lower discharge BP (</= 100 mmHg; the lower tertiles), 
      exploratory subgroups included patients with previous HF hospitalization, 
      inotrope use, New York Heart Association (NYHA) III-IV class, and lower estimated 
      glomerular filtration rate (eGFR) and LVEF (lower than median value). We 
      evaluated the risk-adjusted association between GDMT implementation and 2-year 
      adverse events (all-cause mortality or HF rehospitalization). RESULTS: Among the 
      2043 patients (age 74 [63-82] years), the median systolic BP was 108 (98-120) 
      mmHg. Among patients with lower BP, GDMT prescription rate was 62.7%, and GDMT 
      use was associated with decreased adverse events (HR:0.74, 95%CI:0.58-0.94). GDMT 
      prescription rates were lower among higher-NYHA class and lower-eGFR subgroups 
      compared with their reference subgroups, and directionally similar outcomes were 
      noted in all subgroups (favoring GDMT use); however, this association was 
      somewhat attenuated in the lower-eGFR group (HR:0.87, 95%CI:0.64-1.17). 
      CONCLUSIONS: Conventional GDMT use was associated with decreased adverse outcomes 
      in most patients with HF compounded by systolic dysfunction and low BP, albeit 
      caution is warranted in patients with renal dysfunction.
CI  - Copyright (c) 2022 Elsevier B.V. All rights reserved.
FAU - Izumi, Keiichi
AU  - Izumi K
AD  - Department of Cardiovascular Medicine, Kyorin University Faculty of Medicine, 
      Tokyo, Japan.
FAU - Kohno, Takashi
AU  - Kohno T
AD  - Department of Cardiovascular Medicine, Kyorin University Faculty of Medicine, 
      Tokyo, Japan. Electronic address: kohno-ta@ks.kyorin-u.ac.jp.
FAU - Goda, Ayumi
AU  - Goda A
AD  - Department of Cardiovascular Medicine, Kyorin University Faculty of Medicine, 
      Tokyo, Japan.
FAU - Takeuchi, Shinsuke
AU  - Takeuchi S
AD  - Department of Cardiovascular Medicine, Kyorin University Faculty of Medicine, 
      Tokyo, Japan.
FAU - Shiraishi, Yasuyuki
AU  - Shiraishi Y
AD  - Department of Cardiology, Keio University School of Medicine, Tokyo, Japan.
FAU - Saji, Mike
AU  - Saji M
AD  - Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan.
FAU - Nagatomo, Yuji
AU  - Nagatomo Y
AD  - Department of Cardiology, National Defense Medical College, Tokorozawa, Japan.
FAU - Tanaka, Toshikazu D
AU  - Tanaka TD
AD  - Division of Cardiology, Department of Internal Medicine, The Jikei University 
      School of Medicine, Tokyo, Japan.
FAU - Takei, Makoto
AU  - Takei M
AD  - Department of Cardiology, Tokyo Saiseikai Central Hospital, Tokyo, Japan.
FAU - Nakano, Shintaro
AU  - Nakano S
AD  - Department of Cardiology, Saitama Medical University, International Medical 
      Center, Saitama, Japan.
FAU - Soejima, Kyoko
AU  - Soejima K
AD  - Department of Cardiovascular Medicine, Kyorin University Faculty of Medicine, 
      Tokyo, Japan.
FAU - Kohsaka, Shun
AU  - Kohsaka S
AD  - Department of Cardiology, Keio University School of Medicine, Tokyo, Japan.
FAU - Yoshikawa, Tsutomu
AU  - Yoshikawa T
AD  - Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan.
CN  - West Tokyo Heart Failure Registry Investigators
LA  - eng
PT  - Journal Article
DEP - 20221019
PL  - Netherlands
TA  - Int J Cardiol
JT  - International journal of cardiology
JID - 8200291
SB  - IM
CIN - Int J Cardiol. 2023 Feb 1;372:83-84. PMID: 36503083
MH  - Humans
MH  - Aged
MH  - Stroke Volume
MH  - Ventricular Function, Left
MH  - *Heart Failure/diagnosis/drug therapy
MH  - *Ventricular Dysfunction, Left
MH  - *Hypotension
OTO - NOTNLM
OT  - Blood pressure
OT  - Guideline-directed medical therapy
OT  - Heart failure
OT  - Outcome
EDAT- 2022/10/22 06:00
MHDA- 2022/12/15 06:00
CRDT- 2022/10/21 19:26
PHST- 2022/06/11 00:00 [received]
PHST- 2022/09/23 00:00 [revised]
PHST- 2022/10/16 00:00 [accepted]
PHST- 2022/10/22 06:00 [pubmed]
PHST- 2022/12/15 06:00 [medline]
PHST- 2022/10/21 19:26 [entrez]
AID - S0167-5273(22)01640-0 [pii]
AID - 10.1016/j.ijcard.2022.10.129 [doi]
PST - ppublish
SO  - Int J Cardiol. 2023 Jan 1;370:255-262. doi: 10.1016/j.ijcard.2022.10.129. Epub 
      2022 Oct 19.