Patients with heart failure and reduced ejection fraction (HFrEF) who have low systolic blood pressure and renal dysfunction were found to have better survival outcomes when treated with all 3 guideline-directed pharmacotherapies, according to a study published in Clinical Research in Cardiology.

Guideline-directed medical therapy for patients with HFrEF includes angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers (ACEIs/ARBs), β-blockers (BBs), and mineralocorticoid receptor antagonists (MRA).

A total of 1464 patients with HFrEF, systolic blood pressure ≤100 mmHg, and renal dysfunction (estimated glomerular filtration rate [eGFR] ≤60 mL/ min/1.73m2) were enrolled from the Swedish Heart Failure Registry. The study’s outcome was time to all-cause mortality.


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All study participants were receiving oral medication for heart failure and were categorized into 4 groups, based on the medication combination they were treated with: ACEI/ARB+BB+MRA (group 1; n=485; mean age, 72.9 years; 72.4% men); ACEI/ARB+BB (group 2; n=672; mean age, 76.1 years; 71.1% men); ACEI/ARB+MRA or ACEI/ARB only (group 3; n=109; mean age, 77.4 years; 73.4% men); and other (group 4; n=198; mean age, 79.5 years; 74.7% men). Patients in group 1 had the highest mean level of hemoglobin level (131.9 g/L; P <.0001).

During the follow-up period (median, 1.33 years), 937 patients (64%) died. After adjusting for age, gender, left ventricular ejection fraction, eGFR, and hemoglobin, the hazard ratio for all-cause mortality was 1.04 in group 2 (0.89-1.21; P = .62), 1.40 in group 3 (1.09-1.79; P = .009), and 1.71 in group 4 (1.39-2.09; P < .001), when compared with group 1.

“[Patients with] HFrEF treated with all 3 guideline-directed medical therapy had lower risk for all-cause mortality, and the outcome was better in those treated with ≥50% of the target dose,” noted the researchers.

Study limitations include the fact that is the cohort was from a Swedish registry, so that the results may not be generalizable to other populations or geographic regions, as well as the fact that data on drugs were for those taken at enrollment, so that changes in medical therapy were not accounted for.

“About one-third of the patients [with HFrEF] with low systolic blood pressure and renal dysfunction were treated with all 3 guideline-directed medical therapy drugs, and these patients are associated with a better outcome than those treated with only ACEI/ARB or BB,” the researchers concluded. “The benefit was larger close to the index date and decreased with follow-up time.”

Reference

Chen X, Cui X, Thunström E, et al. Guideline‑directed medical therapy in real‑world heart failure patients with low blood pressure and renal dysfunction. Clin Res Cardiol. doi: 10.1007/s00392-020-01790-y