Blood pressure and intensive treatment up‐titration after acute heart failure hospitalization: Insights from the STRONG‐HF trial
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 implementa...
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| Veröffentlicht in: | European journal of heart failure 2024-03, Vol.26 (3), p.638-651 |
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| creator | Pagnesi, Matteo Vilamajó, Oscar Alberto Gomez Meiriño, Alejandro Dumont, Carlos Alberto Mebazaa, Alexandre Davison, Beth Adamo, Marianna Arrigo, Mattia Barros, Marianela Biegus, Jan Celutkiene, Jelena Čerlinskaitė‐Bajorė, Kamilė Chioncel, Ovidiu Cohen‐Solal, Alain Damasceno, Albertino Diaz, Rafael Edwards, Christopher Filippatos, Gerasimos Gayat, Etienne Kimmoun, Antoine Lam, Carolyn S.P. Novosadova, Maria Pang, Peter S. Ponikowski, Piotr Saidu, Hadiza Sliwa, Karen Takagi, Koji Maaten, Jozine M. Tomasoni, Daniela Voors, Adriaan A. Cotter, Gad Metra, Marco |
| description | 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 ( |
| doi_str_mv | 10.1002/ejhf.3174 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2938284264</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2938284264</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3254-4d560a84d7912d234c608ec04adc7cfea2e6390a9f4cbdf997ae541e869013d73</originalsourceid><addsrcrecordid>eNp1kEtuFDEQQC0EIh9YcAHkJSw68W-6bXYQZTJBEZEgrFsVu0w76h-2G5SsWHAAzshJ8GQCO1ZVUj29kh4hLzg74oyJY7zp_JHkjXpE9rluTMW0Uo_LLrWujFZijxykdMMYbwr-lOzJcleC1_vk57t-mhydI6a0RKQwOhrGjGMK35DmiJAHHDNd5t8_fuWQI-QwjRR8xkjBLhlphxAz9RD6raCb0hwy9OHunnxDz4vqS5cT9XEaaO6Qfrr6ePnhrPg26_IhQP-MPPHQJ3z-MA_J5_Xp1cmmurg8Oz95e1FZKVaqUm5VM9DKNYYLJ6SyNdNomQJnG-sRBNbSMDBe2WvnjWkAV4qjrg3j0jXykLzaeec4fV0w5XYIyWLfw4jTklphpBYlV60K-nqH2jilFNG3cwwDxNuWs3Ybvd1Gb7fRC_vyQbtcD-j-kX8rF-B4B3wPPd7-39Sevt-s75V_AF-_kDA</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2938284264</pqid></control><display><type>article</type><title>Blood pressure and intensive treatment up‐titration after acute heart failure hospitalization: Insights from the STRONG‐HF trial</title><source>MEDLINE</source><source>Wiley Online Library Journals Frontfile Complete</source><source>EZB-FREE-00999 freely available EZB journals</source><creator>Pagnesi, Matteo ; Vilamajó, Oscar Alberto Gomez ; Meiriño, Alejandro ; Dumont, Carlos Alberto ; Mebazaa, Alexandre ; Davison, Beth ; Adamo, Marianna ; Arrigo, Mattia ; Barros, Marianela ; Biegus, Jan ; Celutkiene, Jelena ; Čerlinskaitė‐Bajorė, Kamilė ; Chioncel, Ovidiu ; Cohen‐Solal, Alain ; Damasceno, Albertino ; Diaz, Rafael ; Edwards, Christopher ; Filippatos, Gerasimos ; Gayat, Etienne ; Kimmoun, Antoine ; Lam, Carolyn S.P. ; Novosadova, Maria ; Pang, Peter S. ; Ponikowski, Piotr ; Saidu, Hadiza ; Sliwa, Karen ; Takagi, Koji ; Maaten, Jozine M. ; Tomasoni, Daniela ; Voors, Adriaan A. ; Cotter, Gad ; Metra, Marco</creator><creatorcontrib>Pagnesi, Matteo ; Vilamajó, Oscar Alberto Gomez ; Meiriño, Alejandro ; Dumont, Carlos Alberto ; Mebazaa, Alexandre ; Davison, Beth ; Adamo, Marianna ; Arrigo, Mattia ; Barros, Marianela ; Biegus, Jan ; Celutkiene, Jelena ; Čerlinskaitė‐Bajorė, Kamilė ; Chioncel, Ovidiu ; Cohen‐Solal, Alain ; Damasceno, Albertino ; Diaz, Rafael ; Edwards, Christopher ; Filippatos, Gerasimos ; Gayat, Etienne ; Kimmoun, Antoine ; Lam, Carolyn S.P. ; Novosadova, Maria ; Pang, Peter S. ; Ponikowski, Piotr ; Saidu, Hadiza ; Sliwa, Karen ; Takagi, Koji ; Maaten, Jozine M. ; Tomasoni, Daniela ; Voors, Adriaan A. ; Cotter, Gad ; Metra, Marco</creatorcontrib><description>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.</description><identifier>ISSN: 1388-9842</identifier><identifier>EISSN: 1879-0844</identifier><identifier>DOI: 10.1002/ejhf.3174</identifier><identifier>PMID: 38444216</identifier><language>eng</language><publisher>Oxford, UK: John Wiley & Sons, Ltd</publisher><subject>Acute Disease ; Acute heart failure ; Aged ; Blood pressure ; Blood Pressure - drug effects ; Blood Pressure - physiology ; Female ; Heart failure ; Heart Failure - drug therapy ; Heart Failure - physiopathology ; Heart Failure - therapy ; Hospitalization ; Humans ; Hypotension ; Male ; Medical therapy ; Middle Aged ; Randomized trial ; Treatment Outcome</subject><ispartof>European journal of heart failure, 2024-03, Vol.26 (3), p.638-651</ispartof><rights>2024 European Society of Cardiology.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3254-4d560a84d7912d234c608ec04adc7cfea2e6390a9f4cbdf997ae541e869013d73</citedby><cites>FETCH-LOGICAL-c3254-4d560a84d7912d234c608ec04adc7cfea2e6390a9f4cbdf997ae541e869013d73</cites><orcidid>0000-0001-6691-8568</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2Fejhf.3174$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2Fejhf.3174$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,776,780,1411,27901,27902,45550,45551</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/38444216$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Pagnesi, Matteo</creatorcontrib><creatorcontrib>Vilamajó, Oscar Alberto Gomez</creatorcontrib><creatorcontrib>Meiriño, Alejandro</creatorcontrib><creatorcontrib>Dumont, Carlos Alberto</creatorcontrib><creatorcontrib>Mebazaa, Alexandre</creatorcontrib><creatorcontrib>Davison, Beth</creatorcontrib><creatorcontrib>Adamo, Marianna</creatorcontrib><creatorcontrib>Arrigo, Mattia</creatorcontrib><creatorcontrib>Barros, Marianela</creatorcontrib><creatorcontrib>Biegus, Jan</creatorcontrib><creatorcontrib>Celutkiene, Jelena</creatorcontrib><creatorcontrib>Čerlinskaitė‐Bajorė, Kamilė</creatorcontrib><creatorcontrib>Chioncel, Ovidiu</creatorcontrib><creatorcontrib>Cohen‐Solal, Alain</creatorcontrib><creatorcontrib>Damasceno, Albertino</creatorcontrib><creatorcontrib>Diaz, Rafael</creatorcontrib><creatorcontrib>Edwards, Christopher</creatorcontrib><creatorcontrib>Filippatos, Gerasimos</creatorcontrib><creatorcontrib>Gayat, Etienne</creatorcontrib><creatorcontrib>Kimmoun, Antoine</creatorcontrib><creatorcontrib>Lam, Carolyn S.P.</creatorcontrib><creatorcontrib>Novosadova, Maria</creatorcontrib><creatorcontrib>Pang, Peter S.</creatorcontrib><creatorcontrib>Ponikowski, Piotr</creatorcontrib><creatorcontrib>Saidu, Hadiza</creatorcontrib><creatorcontrib>Sliwa, Karen</creatorcontrib><creatorcontrib>Takagi, Koji</creatorcontrib><creatorcontrib>Maaten, Jozine M.</creatorcontrib><creatorcontrib>Tomasoni, Daniela</creatorcontrib><creatorcontrib>Voors, Adriaan A.</creatorcontrib><creatorcontrib>Cotter, Gad</creatorcontrib><creatorcontrib>Metra, Marco</creatorcontrib><title>Blood pressure and intensive treatment up‐titration after acute heart failure hospitalization: Insights from the STRONG‐HF trial</title><title>European journal of heart failure</title><addtitle>Eur J Heart Fail</addtitle><description>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.</description><subject>Acute Disease</subject><subject>Acute heart failure</subject><subject>Aged</subject><subject>Blood pressure</subject><subject>Blood Pressure - drug effects</subject><subject>Blood Pressure - physiology</subject><subject>Female</subject><subject>Heart failure</subject><subject>Heart Failure - drug therapy</subject><subject>Heart Failure - physiopathology</subject><subject>Heart Failure - therapy</subject><subject>Hospitalization</subject><subject>Humans</subject><subject>Hypotension</subject><subject>Male</subject><subject>Medical therapy</subject><subject>Middle Aged</subject><subject>Randomized trial</subject><subject>Treatment Outcome</subject><issn>1388-9842</issn><issn>1879-0844</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kEtuFDEQQC0EIh9YcAHkJSw68W-6bXYQZTJBEZEgrFsVu0w76h-2G5SsWHAAzshJ8GQCO1ZVUj29kh4hLzg74oyJY7zp_JHkjXpE9rluTMW0Uo_LLrWujFZijxykdMMYbwr-lOzJcleC1_vk57t-mhydI6a0RKQwOhrGjGMK35DmiJAHHDNd5t8_fuWQI-QwjRR8xkjBLhlphxAz9RD6raCb0hwy9OHunnxDz4vqS5cT9XEaaO6Qfrr6ePnhrPg26_IhQP-MPPHQJ3z-MA_J5_Xp1cmmurg8Oz95e1FZKVaqUm5VM9DKNYYLJ6SyNdNomQJnG-sRBNbSMDBe2WvnjWkAV4qjrg3j0jXykLzaeec4fV0w5XYIyWLfw4jTklphpBYlV60K-nqH2jilFNG3cwwDxNuWs3Ybvd1Gb7fRC_vyQbtcD-j-kX8rF-B4B3wPPd7-39Sevt-s75V_AF-_kDA</recordid><startdate>202403</startdate><enddate>202403</enddate><creator>Pagnesi, Matteo</creator><creator>Vilamajó, Oscar Alberto Gomez</creator><creator>Meiriño, Alejandro</creator><creator>Dumont, Carlos Alberto</creator><creator>Mebazaa, Alexandre</creator><creator>Davison, Beth</creator><creator>Adamo, Marianna</creator><creator>Arrigo, Mattia</creator><creator>Barros, Marianela</creator><creator>Biegus, Jan</creator><creator>Celutkiene, Jelena</creator><creator>Čerlinskaitė‐Bajorė, Kamilė</creator><creator>Chioncel, Ovidiu</creator><creator>Cohen‐Solal, Alain</creator><creator>Damasceno, Albertino</creator><creator>Diaz, Rafael</creator><creator>Edwards, Christopher</creator><creator>Filippatos, Gerasimos</creator><creator>Gayat, Etienne</creator><creator>Kimmoun, Antoine</creator><creator>Lam, Carolyn S.P.</creator><creator>Novosadova, Maria</creator><creator>Pang, Peter S.</creator><creator>Ponikowski, Piotr</creator><creator>Saidu, Hadiza</creator><creator>Sliwa, Karen</creator><creator>Takagi, Koji</creator><creator>Maaten, Jozine M.</creator><creator>Tomasoni, Daniela</creator><creator>Voors, Adriaan A.</creator><creator>Cotter, Gad</creator><creator>Metra, Marco</creator><general>John Wiley & Sons, Ltd</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0001-6691-8568</orcidid></search><sort><creationdate>202403</creationdate><title>Blood pressure and intensive treatment up‐titration after acute heart failure hospitalization: Insights from the STRONG‐HF trial</title><author>Pagnesi, Matteo ; Vilamajó, Oscar Alberto Gomez ; Meiriño, Alejandro ; Dumont, Carlos Alberto ; Mebazaa, Alexandre ; Davison, Beth ; Adamo, Marianna ; Arrigo, Mattia ; Barros, Marianela ; Biegus, Jan ; Celutkiene, Jelena ; Čerlinskaitė‐Bajorė, Kamilė ; Chioncel, Ovidiu ; Cohen‐Solal, Alain ; Damasceno, Albertino ; Diaz, Rafael ; Edwards, Christopher ; Filippatos, Gerasimos ; Gayat, Etienne ; Kimmoun, Antoine ; Lam, Carolyn S.P. ; Novosadova, Maria ; Pang, Peter S. ; Ponikowski, Piotr ; Saidu, Hadiza ; Sliwa, Karen ; Takagi, Koji ; Maaten, Jozine M. ; Tomasoni, Daniela ; Voors, Adriaan A. ; Cotter, Gad ; Metra, Marco</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3254-4d560a84d7912d234c608ec04adc7cfea2e6390a9f4cbdf997ae541e869013d73</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Acute Disease</topic><topic>Acute heart failure</topic><topic>Aged</topic><topic>Blood pressure</topic><topic>Blood Pressure - drug effects</topic><topic>Blood Pressure - physiology</topic><topic>Female</topic><topic>Heart failure</topic><topic>Heart Failure - drug therapy</topic><topic>Heart Failure - physiopathology</topic><topic>Heart Failure - therapy</topic><topic>Hospitalization</topic><topic>Humans</topic><topic>Hypotension</topic><topic>Male</topic><topic>Medical therapy</topic><topic>Middle Aged</topic><topic>Randomized trial</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Pagnesi, Matteo</creatorcontrib><creatorcontrib>Vilamajó, Oscar Alberto Gomez</creatorcontrib><creatorcontrib>Meiriño, Alejandro</creatorcontrib><creatorcontrib>Dumont, Carlos Alberto</creatorcontrib><creatorcontrib>Mebazaa, Alexandre</creatorcontrib><creatorcontrib>Davison, Beth</creatorcontrib><creatorcontrib>Adamo, Marianna</creatorcontrib><creatorcontrib>Arrigo, Mattia</creatorcontrib><creatorcontrib>Barros, Marianela</creatorcontrib><creatorcontrib>Biegus, Jan</creatorcontrib><creatorcontrib>Celutkiene, Jelena</creatorcontrib><creatorcontrib>Čerlinskaitė‐Bajorė, Kamilė</creatorcontrib><creatorcontrib>Chioncel, Ovidiu</creatorcontrib><creatorcontrib>Cohen‐Solal, Alain</creatorcontrib><creatorcontrib>Damasceno, Albertino</creatorcontrib><creatorcontrib>Diaz, Rafael</creatorcontrib><creatorcontrib>Edwards, Christopher</creatorcontrib><creatorcontrib>Filippatos, Gerasimos</creatorcontrib><creatorcontrib>Gayat, Etienne</creatorcontrib><creatorcontrib>Kimmoun, Antoine</creatorcontrib><creatorcontrib>Lam, Carolyn S.P.</creatorcontrib><creatorcontrib>Novosadova, Maria</creatorcontrib><creatorcontrib>Pang, Peter S.</creatorcontrib><creatorcontrib>Ponikowski, Piotr</creatorcontrib><creatorcontrib>Saidu, Hadiza</creatorcontrib><creatorcontrib>Sliwa, Karen</creatorcontrib><creatorcontrib>Takagi, Koji</creatorcontrib><creatorcontrib>Maaten, Jozine M.</creatorcontrib><creatorcontrib>Tomasoni, Daniela</creatorcontrib><creatorcontrib>Voors, Adriaan A.</creatorcontrib><creatorcontrib>Cotter, Gad</creatorcontrib><creatorcontrib>Metra, Marco</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>European journal of heart failure</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Pagnesi, Matteo</au><au>Vilamajó, Oscar Alberto Gomez</au><au>Meiriño, Alejandro</au><au>Dumont, Carlos Alberto</au><au>Mebazaa, Alexandre</au><au>Davison, Beth</au><au>Adamo, Marianna</au><au>Arrigo, Mattia</au><au>Barros, Marianela</au><au>Biegus, Jan</au><au>Celutkiene, Jelena</au><au>Čerlinskaitė‐Bajorė, Kamilė</au><au>Chioncel, Ovidiu</au><au>Cohen‐Solal, Alain</au><au>Damasceno, Albertino</au><au>Diaz, Rafael</au><au>Edwards, Christopher</au><au>Filippatos, Gerasimos</au><au>Gayat, Etienne</au><au>Kimmoun, Antoine</au><au>Lam, Carolyn S.P.</au><au>Novosadova, Maria</au><au>Pang, Peter S.</au><au>Ponikowski, Piotr</au><au>Saidu, Hadiza</au><au>Sliwa, Karen</au><au>Takagi, Koji</au><au>Maaten, Jozine M.</au><au>Tomasoni, Daniela</au><au>Voors, Adriaan A.</au><au>Cotter, Gad</au><au>Metra, Marco</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Blood pressure and intensive treatment up‐titration after acute heart failure hospitalization: Insights from the STRONG‐HF trial</atitle><jtitle>European journal of heart failure</jtitle><addtitle>Eur J Heart Fail</addtitle><date>2024-03</date><risdate>2024</risdate><volume>26</volume><issue>3</issue><spage>638</spage><epage>651</epage><pages>638-651</pages><issn>1388-9842</issn><eissn>1879-0844</eissn><abstract>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.</abstract><cop>Oxford, UK</cop><pub>John Wiley & Sons, Ltd</pub><pmid>38444216</pmid><doi>10.1002/ejhf.3174</doi><tpages>14</tpages><orcidid>https://orcid.org/0000-0001-6691-8568</orcidid></addata></record> |
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| ispartof | European journal of heart failure, 2024-03, Vol.26 (3), p.638-651 |
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| source | MEDLINE; Wiley Online Library Journals Frontfile Complete; EZB-FREE-00999 freely available EZB journals |
| subjects | Acute Disease Acute heart failure Aged Blood pressure Blood Pressure - drug effects Blood Pressure - physiology Female Heart failure Heart Failure - drug therapy Heart Failure - physiopathology Heart Failure - therapy Hospitalization Humans Hypotension Male Medical therapy Middle Aged Randomized trial Treatment Outcome |
| title | Blood pressure and intensive treatment up‐titration after acute heart failure hospitalization: Insights from the STRONG‐HF trial |
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