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Multiple neurohumoral modulating agents in systolic dysfunction heart failure: are we lowering blood pressure too
George Mak1, Niamh F Murphy, Akbar Ali
1Heart Failure Unit, St Vincent's University Hospital, Dublin 4, Ireland.
Insights
Optimizing heart failure medications can increase hypotension episodes, even with normal clinic blood pressure. This increased diastolic hypotension burden predicts higher heart failure readmissions and mortality.
Area of Science:
- Cardiology
- Pharmacology
- Hypertension Research
Background:
- Disease-modifying drugs for heart failure (HF) impact blood pressure.
- Clinic blood pressure guides medication titration, but diurnal patterns are poorly understood.
- Impact of HF medication titration on 24-hour blood pressure requires further investigation.
Purpose of the Study:
- To assess the effect of neurohumoral modulating agents on ambulatory blood pressure monitoring (ABPM) in systolic HF.
- To investigate the link between hypotension burden and clinical outcomes in HF patients.
Main Methods:
- Prospective analysis of 45 HF patients during medication initiation/optimization.
- Cross-sectional analysis of 144 HF patients.
- Utilized ambulatory blood pressure monitoring (ABPM) to assess diurnal blood pressure variations.
Main Results:
- Medication titration significantly increased daytime systolic and diastolic hypotensive episodes.
- No significant change in clinic blood pressure was observed post-titration.
- Higher diastolic hypotensive episodes correlated with increased HF readmissions and mortality.
Conclusions:
- Neurohumoral agents can increase 24-hour hypotension burden despite stable clinic readings.
- Diastolic hypotension burden is an independent predictor of HF readmissions and mortality.
- Ambulatory blood pressure monitoring is crucial for assessing medication effects in HF.
Background:
Disease-modifying drug treatment in heart failure (HF) reduces blood pressure. Titration of these agents is guided by clinic blood pressure readings; however, the impact of such treatment on blood pressure is unknown because diurnal blood pressure patterns remain poorly described. The aim of this study was to examine the impact of additional neurohumoral modulating agents on ambulatory blood pressure monitoring (ABPM) control in patients with systolic HF and examine the relationship between the burden of hypotension and clinical outcomes.
Methods And Results:
In a prospective analysis on 45 patients undergoing initiation and optimization of additional medications (angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, or beta-blockers), mean daytime systolic (P = .035) and mean daytime and nocturnal diastolic hypotensive episodes (both P < .001) increased significantly posttitration. There was no change in clinic blood pressure before and after titration. In a cross-sectional analysis on 144 patients, those with the most diastolic hypotensive episodes had higher rates of HF readmissions (P = .01) and the composite end point of all-cause mortality and all-cause readmissions (P = .03).
Conclusions:
Additional neurohumoral modulating agents could produce significant increases in 24-hour hypotension burden despite reassuring clinic blood pressure readings. The burden of diastolic hypotension is independently predictive of HF readmissions and the composite end point of all-cause mortality and emergency readmissions.
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