Heart failure & cardiomyopathiesMeta-analysis
Effects of pharmacological blood pressure lowering in heart failure with mildly reduced or preserved ejection fraction: a meta-analysis
- systematic review and meta-analysis of randomised clinical trials
- random effects meta-analysis and meta-regression with inverse variance weighting
Authors' conclusion
In patients with HFmrEF/HFpEF, there was no significant association between pharmacological BP lowering and clinical outcomes, suggesting that BP lowering alone is unlikely to explain all the benefits observed with the use of recently established HF therapies.
Study context
- Population
- Patients with heart failure (HF) with mildly reduced or preserved ejection fraction (HFmrEF/HFpEF)
- Participants
- 39,452 patients · 18 studies
- Comparison
- any blood pressure (BP) lowering treatment to placebo, usual care or another drug class
- Outcome
- Composite of:
- Cardiovascular death
- HF hospitalisation
Pooled result
As reported in the abstract
Relative risk
0.86
95% CI 0.83–0.89
P ≤ 0.001
Pharmacological BP lowering vs placebo, usual care or another drug class
RR 0.86 (95% CI 0.83–0.89); P ≤ 0.001
- significant differences between drug classes
- P = 0.018
- Meta-regression: association between degree of BP reduction and treatment effects, coefficient slope
- −0.0125, p=0.304
Further pooled results
| Outcome | RR (95% CI) | P value | |
|---|---|---|---|
| HF hospitalisations · treatment effects were not related to degree of BP reduction | 0.83 (0.79–0.86) | P ≤ 0.001 | |
| 0.512Relative risk (log scale) |
- HF hospitalisations — Meta-regression: treatment effects vs degree of BP reduction, coefficient slope
- −0.0121, p=0.528
Original publication
Effects of pharmacological blood pressure lowering in heart failure with mildly reduced or preserved ejection fraction: a meta-analysis. Heart. Published 3 August 2026. doi:10.1136/heartjnl-2026-327872
Summarised from the published abstract; every number is checked against it