Heart failure & cardiomyopathies
Dapagliflozin and Apparent Treatment-Resistant Hypertension in Heart Failure With Mildly Reduced or Preserved Ejection Fraction: The DELIVER Trial
Authors' conclusion
aTRH was identified in >1 in 10 patients with heart failure and left ventricular ejection fraction >40% in DELIVER. Dapagliflozin consistently improved clinical outcomes and was well-tolerated, including among those with aTRH.
Study context
- Population
- HF with mildly reduced or preserved EF (DELIVER participants)
- Participants
- 6,263 participants
- Comparison
- Dapagliflozin vs placebo, by baseline blood pressure (BP) category
- Controlled BPn = 3,766
- Nonresistant hypertensionn = 1,779
- Apparent treatment-resistant hypertension (aTRH)n = 718
- Primary endpoint
- CV death or worsening HF event
Methodological detailspost hoc analysis
- Post hoc analysis
Primary result
As reported in the abstract
CV death or worsening HF event, by baseline BP category
| Group | Value | Absolute reduction with dapagliflozin |
|---|---|---|
| Controlled BP | 8.7 per 100 patient-years | 0.8 per 100 patient-years |
| Nonresistant hypertension | 8.5 per 100 patient-years | 2.7 per 100 patient-years |
| aTRH | 9.5 per 100 patient-years | 4.1 per 100 patient-years |
Value
Controlled BP8.7 per 100 patient-years
Nonresistant hypertension8.5 per 100 patient-years
aTRH9.5 per 100 patient-years
Absolute reduction with dapagliflozin
Controlled BP0.8 per 100 patient-years
Nonresistant hypertension2.7 per 100 patient-years
aTRH4.1 per 100 patient-years
- Relative benefit of dapagliflozin vs placebo consistent across BP categories
- P for interaction = 0.114
Secondary outcomes
Vascular events incl. MI and stroke
- Higher rate in aTRH irrespective of assigned treatment
SBP
- Dapagliflozin modestly reduced SBP, irrespective of BP category
- ≈1 to 3 mm Hg
- No improvement in proportion with aTRH attaining goal BP over time
Original publication
Dapagliflozin and Apparent Treatment-Resistant Hypertension in Heart Failure With Mildly Reduced or Preserved Ejection Fraction: The DELIVER Trial. Circulation. Published 13 October 2023. doi:10.
Summarised from the published abstract; every number is checked against it