Lower Systolic BP in HFrEF Patients Linked to Mortality

By Kelly Young

Edited by David G. Fairchild, MD, MPH, and Jaye Elizabeth Hefner, MD

For patients with heart failure with reduced ejection fraction (HFrEF), systolic blood pressure (SBP) below 130 mm Hg is associated with greater mortality risk than higher SBP, according to an observational study in the Journal of the American College of Cardiology. Current guidelines recommend maintaining an SBP of less than 130 in patients with HFrEF and hypertension.

Using a registry linked to Medicare claims, researchers matched roughly 1200 seniors hospitalized for HFrEF who had a stable discharge SBP of less than 130 mm Hg with similar patients who had a higher SBP.

Thirty-day all-cause mortality was significantly higher in those with an SBP of less than 130 (7% vs. 4% for higher SBP). The risk was still elevated after 6 years. The risk for all-cause and heart failure readmissions became significant after 12 months of follow-up.

The authors conclude: "Clinicians need to exercise caution in lowering SBP with agents other than guideline-recommended neurohormonal antagonists in patients with HFrEF who have SBP [at or above] 130 mm Hg and are already receiving [guideline-directed medical therapy] in optimal doses."