Heart failure & cardiomyopathiesCohort study
Hypotension in Heart Failure is Less Harmful if Associated with High or Increasing Doses of Heart Failure Medication: Insights from the Swedish Heart Failure Registry
- Registry-based cohort study
- Swedish heart failure (HF) registry
Authors' conclusion
The association of lower SBP with higher risk of CVD/HFH is attenuated in patients with optimized HF medication.
Study context
- Population
- Patients with HF with reduced ejection fraction (HFrEF) in the Swedish HF registry (2000–2018)median age 74.0
- Participants
- 42,040 patients
- Exposure
- Association of systolic BP (SBP) with outcomes by HF medication dose
- Outcome
- CV death and/or HF hospitalisation (cardiovascular death (CVD)/HF hospitalization (HFH))
Main finding
CVD/HFH per 10 mmHg higher baseline SBP
Adjusted hazard ratio
0.92
95% CI 0.92–0.93
per 10 mmHg higher SBP
adjusted HR 0.92 (95% CI 0.92–0.93)
Per 10 mmHg higher SBP, as printed
As reported in the abstract
- Event-rate decrease per 10 mmHg SBP increase, untreated patients
- 10%
- Event-rate decrease per 10 mmHg SBP increase, patients at maximum renin-angiotensin system (RAS) inhibitor and beta-blocker dose
- 7%
Observational data: associations, not effects.
Further findings
CV death/HF hospitalisation with decreasing SBP, by HF medication dose change
| Comparison | HR (95% CI) | |
|---|---|---|
| Decreasing SBP · stable dose | 1.10 (1.04–1.17) | |
| Decreasing SBP · decreasing dose | 1.29 (1.18–1.42) | |
| Decreasing SBP · increase in doses | 0.94 (0.86–1.02) | |
| 0.512Hazard ratio (log scale) |
| Outcome | Values | Estimate |
|---|---|---|
| SBP decrease >10 mmHg by HF medication dose change (patients with repeated measurements) | Increased doses 9.9% · Stable/decreasing doses 24.6% |
- SBP decrease >10 mmHg by HF medication dose change (patients with repeated measurements): n = 13 761 with repeated measurements
Original publication
Hypotension in Heart Failure is Less Harmful if Associated with High or Increasing Doses of Heart Failure Medication: Insights from the Swedish Heart Failure Registry. Eur J Heart Fail. Published 21 November 2023. doi:10.1002/ejhf.3066
Summarised from the published abstract; every number is checked against it