TY - JOUR
T1 - Blood pressure and intensive treatment up-titration after acute heart failure hospitalization
T2 - Insights from the STRONG-HF trial
AU - Pagnesi, Matteo
AU - Vilamajó, Oscar Alberto Gomez
AU - Meiriño, Alejandro
AU - Dumont, Carlos Alberto
AU - Mebazaa, Alexandre
AU - Davison, Beth
AU - Adamo, Marianna
AU - Arrigo, Mattia
AU - Barros, Marianela
AU - Biegus, Jan
AU - Celutkiene, Jelena
AU - Čerlinskaitė-Bajorė, Kamilė
AU - Chioncel, Ovidiu
AU - Cohen-Solal, Alain
AU - Damasceno, Albertino
AU - Diaz, Rafael
AU - Edwards, Christopher
AU - Filippatos, Gerasimos
AU - Gayat, Etienne
AU - Kimmoun, Antoine
AU - Lam, Carolyn S.P.
AU - Novosadova, Maria
AU - Pang, Peter S.
AU - Ponikowski, Piotr
AU - Saidu, Hadiza
AU - Sliwa, Karen
AU - Takagi, Koji
AU - ter Maaten, Jozine M.
AU - Tomasoni, Daniela
AU - Voors, Adriaan A.
AU - Cotter, Gad
AU - Metra, Marco
N1 - Publisher Copyright:
© 2024 European Society of Cardiology.
PY - 2024/3
Y1 - 2024/3
N2 - Aims: A high-intensity care (HIC) strategy with rapid guideline-directed medical therapy (GDMT) up-titration and close follow-up visits improved outcomes, compared to usual care (UC), in patients recently hospitalized for acute heart failure (AHF). Hypotension is a major limitation to GDMT implementation. We aimed to assess the impact of baseline systolic blood pressure (SBP) on the effects of HIC versus UC and the role of early SBP changes in STRONG-HF. Methods and results: A total of 1075 patients hospitalized for AHF with SBP ≥100 mmHg were included in STRONG-HF. For the purpose of this post-hoc analysis, patients were stratified by tertiles of baseline SBP (<118, 118–128, and ≥129 mmHg) and, in the HIC arm, by tertiles of changes in SBP from the values measured before discharge to those measured at 1 week after discharge (≥2 mmHg increase, ≤7 mmHg decrease to <2 mmHg increase, and ≥8 mmHg decrease). The primary endpoint was 180-day heart failure rehospitalization or death. The effect of HIC versus UC on the primary endpoint was independent of baseline SBP evaluated as tertiles (pinteraction = 0.77) or as a continuous variable (pinteraction = 0.91). In the HIC arm, patients with increased, stable and decreased SBP at 1 week reached 83.5%, 76.2% and 75.3% of target doses of GDMT at day 90. The risk of the primary endpoint was not significantly different between patients with different SBP changes at 1 week (adjusted p = 0.46). Conclusions: In STRONG-HF, the benefits of HIC versus UC were independent of baseline SBP. Rapid GDMT up-titration was performed also in patients with an early SBP drop, resulting in similar 180-day outcome as compared to patients with stable or increased SBP.
AB - Aims: A high-intensity care (HIC) strategy with rapid guideline-directed medical therapy (GDMT) up-titration and close follow-up visits improved outcomes, compared to usual care (UC), in patients recently hospitalized for acute heart failure (AHF). Hypotension is a major limitation to GDMT implementation. We aimed to assess the impact of baseline systolic blood pressure (SBP) on the effects of HIC versus UC and the role of early SBP changes in STRONG-HF. Methods and results: A total of 1075 patients hospitalized for AHF with SBP ≥100 mmHg were included in STRONG-HF. For the purpose of this post-hoc analysis, patients were stratified by tertiles of baseline SBP (<118, 118–128, and ≥129 mmHg) and, in the HIC arm, by tertiles of changes in SBP from the values measured before discharge to those measured at 1 week after discharge (≥2 mmHg increase, ≤7 mmHg decrease to <2 mmHg increase, and ≥8 mmHg decrease). The primary endpoint was 180-day heart failure rehospitalization or death. The effect of HIC versus UC on the primary endpoint was independent of baseline SBP evaluated as tertiles (pinteraction = 0.77) or as a continuous variable (pinteraction = 0.91). In the HIC arm, patients with increased, stable and decreased SBP at 1 week reached 83.5%, 76.2% and 75.3% of target doses of GDMT at day 90. The risk of the primary endpoint was not significantly different between patients with different SBP changes at 1 week (adjusted p = 0.46). Conclusions: In STRONG-HF, the benefits of HIC versus UC were independent of baseline SBP. Rapid GDMT up-titration was performed also in patients with an early SBP drop, resulting in similar 180-day outcome as compared to patients with stable or increased SBP.
KW - Acute heart failure
KW - Blood pressure
KW - Heart failure
KW - Medical therapy
KW - Randomized trial
UR - http://www.scopus.com/inward/record.url?scp=85186952640&partnerID=8YFLogxK
U2 - 10.1002/ejhf.3174
DO - 10.1002/ejhf.3174
M3 - Article
C2 - 38444216
AN - SCOPUS:85186952640
SN - 1388-9842
VL - 26
SP - 638
EP - 651
JO - European Journal of Heart Failure
JF - European Journal of Heart Failure
IS - 3
ER -