Jesse F Veenis1,2,3,4,5, Hans-Peter Brunner-La Rocca1,2,3,4,5, Gerard C M Linssen1,2,3,4,5, Marco W F Van Gent1,2,3,4,5, Arno W Hoes1,2,3,4,5, Jasper J Brugts1,2,3,4,5. 1. Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Thorax Center, Rotterdam, the Netherlands (J.F.V., J.J.B.). 2. Department of Cardiology, Maastricht University Medical Center, Maastricht, the Netherlands (H.-P.B.-L.R.). 3. Hospital Group Twente, Department of Cardiology, Almelo and Hengelo, the Netherlands (G.C.M.L.). 4. Albert Schweitzer Ziekenhuis, Department of Cardiology, Dordrecht, the Netherlands (M.W.F.V.G.). 5. Department of Cardiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands (A.W.H.).
Abstract
BACKGROUND: Prescribed dosages of heart failure (HF) therapy in patients with a reduced left ventricular ejection fraction remain lower than guideline recommended. It remains unclear whether systolic blood pressure (BP) influences prescription of HF drugs to HF patients with a reduced left ventricular ejection fraction in a European setting. This study aimed to investigate the role of systolic BP on the prescription rate and actual dose of guideline-recommended HF therapy. METHODS: A total of 8246 patients with chronic HF with a reduced left ventricular ejection fraction from 34 Dutch outpatient HF clinics were included. Detailed information on prescription rates and dosages of HF drugs were assessed according to systolic BP categories (<95, 95-109, 110-129, and ≥130 mm Hg). RESULTS: Patients with systolic BP <95 mm Hg receive more often triple therapy (β-blocker, renin-angiotensin system inhibitor, and mineralocorticoid receptor antagonist; 40.3% versus 30.4% respectively, P<0.001) compared with ≥130 mm Hg. Patients with systolic BP <95 mm Hg received significantly more often mineralocorticoid receptor antagonists (64.5% versus 43.8%), ivabradine (8.3% versus 3.6%), and diuretics (94.2% versus 78.6%) and less often renin-angiotensin system inhibitors (75.4% versus 82.8%) compared with ≥130 mm Hg (P for all trends, <0.001). The prescribed dosages of β-blockers and renin-angiotensin system inhibitors were significantly lower in patients with systolic BP <95 mm Hg compared with ≥130 mm Hg (P for all trends, <0.001). CONCLUSIONS: In this large cross-sectional cohort of patients with reduced left ventricular ejection fraction, patients with lower systolic BP receive more HF drugs but at lower dose relative to the target dose recommended in HF guidelines. Discussion is warranted regarding what target BP is acceptable and what should be limiting factors in uptitration to adequate levels of HF medication.
BACKGROUND: Prescribed dosages of heart failure (HF) therapy in patients with a reduced left ventricular ejection fraction remain lower than guideline recommended. It remains unclear whether systolic blood pressure (BP) influences prescription of HF drugs to HF patients with a reduced left ventricular ejection fraction in a European setting. This study aimed to investigate the role of systolic BP on the prescription rate and actual dose of guideline-recommended HF therapy. METHODS: A total of 8246 patients with chronic HF with a reduced left ventricular ejection fraction from 34 Dutch outpatient HF clinics were included. Detailed information on prescription rates and dosages of HF drugs were assessed according to systolic BP categories (<95, 95-109, 110-129, and ≥130 mm Hg). RESULTS:Patients with systolic BP <95 mm Hg receive more often triple therapy (β-blocker, renin-angiotensin system inhibitor, and mineralocorticoid receptor antagonist; 40.3% versus 30.4% respectively, P<0.001) compared with ≥130 mm Hg. Patients with systolic BP <95 mm Hg received significantly more often mineralocorticoid receptor antagonists (64.5% versus 43.8%), ivabradine (8.3% versus 3.6%), and diuretics (94.2% versus 78.6%) and less often renin-angiotensin system inhibitors (75.4% versus 82.8%) compared with ≥130 mm Hg (P for all trends, <0.001). The prescribed dosages of β-blockers and renin-angiotensin system inhibitors were significantly lower in patients with systolic BP <95 mm Hg compared with ≥130 mm Hg (P for all trends, <0.001). CONCLUSIONS: In this large cross-sectional cohort of patients with reduced left ventricular ejection fraction, patients with lower systolic BP receive more HF drugs but at lower dose relative to the target dose recommended in HF guidelines. Discussion is warranted regarding what target BP is acceptable and what should be limiting factors in uptitration to adequate levels of HF medication.
Entities:
Keywords:
blood pressure; heart failure; outpatients; ventricular function, left
Authors: Martin R Cowie; Jakob Schöpe; Stefan Wagenpfeil; Luigi Tavazzi; Michael Böhm; Piotr Ponikowski; Stefan D Anker; Gerasimos S Filippatos; Michel Komajda Journal: ESC Heart Fail Date: 2021-02-10
Authors: Sumant P Radhoe; Jesse F Veenis; Gerard C M Linssen; Chris van der Lee; Luc W M Eurlings; Hans Kragten; Nadea Y Y Al-Windy; Aukje van der Spank; Stefan Koudstaal; Hans-Peter Brunner-La Rocca; Jasper J Brugts Journal: ESC Heart Fail Date: 2021-12-04