Li Zhuojin, Tao Qinglan, Wu Yutong, Hua Sha, Li Qingchuan, Wang Zhiyan, Chen Yanjia, Li Yan, Qiu Zeping, Jin Wei
Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Heart Failure Center, Ruijin Hospital Lu Wan Branch, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Ann Med. 2025 Dec;57(1):2583558. doi: 10.1080/07853890.2025.2583558. Epub 2025 Nov 7.
Low blood pressure (BP) limits the up-titration of guideline-directed medical therapies (GDMTs) and predicts poor outcomes in heart failure (HF). We assessed the value of ambulatory BP monitoring (ABPM) in detecting low BP and its impact on GDMTs optimization and prognosis in HF.
In 491 HF patients initiating GDMTs from the Risk Evaluation and Management in Heart Failure (REM-HF) study since April 2018 to December 2022, ABPM was measured in addition to office BP. Participants were classified as sustained low systolic BP (SBP) (24-hour and office SBP < 120 mmHg), masked low SBP (24-hour SBP < 120 mmHg, office SBP ≥ 120 mmHg), and no low SBP. The primary outcome was a composite of all-cause mortality and HF rehospitalization. GDMTs target dose achievement was assessed at 3 months. Logistic regression and Cox regression models were used to assess GDMTs optimization and outcomes across SBP groups.
Sustained, masked, and no low SBP were observed in 25.3%, 30.8%, and 44.0% of patients, respectively. Both sustained (OR 2.36, 95%CI 1.25-4.47) and masked low SBP (OR 2.32, 95%CI 1.11-4.87) groups were associated with lower likelihood of achieving GDMTs target doses. Over a median 21-month follow-up, all-cause mortality and HF rehospitalization rates were higher in sustained (HR 2.45, 95% CI 1.56-3.86) and masked low SBP (HR 1.68, 95% CI 1.08-2.62) groups. No difference was found in the target dose achievement and outcomes between the two low SBP groups.
Sustained and masked low SBP were common in HF and both associated with GDMTs intolerance and adverse outcomes.
低血压限制了指南导向的药物治疗（GDMT）的剂量上调，并预示着心力衰竭（HF）的不良预后。我们评估了动态血压监测（ABPM）在检测低血压及其对HF患者GDMT优化和预后的影响方面的价值。
在2018年4月至2022年12月期间，对491例来自心力衰竭风险评估与管理（REM-HF）研究且开始接受GDMT的HF患者，除了测量诊室血压外，还进行了ABPM测量。参与者被分为持续性低收缩压（SBP）组（24小时和诊室SBP均<120mmHg）、隐匿性低SBP组（24小时SBP<120mmHg，诊室SBP≥120mmHg）和无低SBP组。主要结局是全因死亡率和HF再住院的复合结局。在3个月时评估GDMT目标剂量的达成情况。使用逻辑回归和Cox回归模型评估不同SBP组之间的GDMT优化情况和结局。
分别有25.3%、30.8%和44.0%的患者为持续性、隐匿性和无低SBP。持续性（比值比[OR]2.36，95%置信区间[CI]1.25-4.47）和隐匿性低SBP组（OR 2.32，95%CI 1.11-4.87）实现GDMT目标剂量的可能性均较低。在中位21个月的随访中，持续性（风险比[HR]2.45，95%CI 1.56-3.86）和隐匿性低SBP组（HR 1.68，95%CI 1.08-2.62）的全因死亡率和HF再住院率更高。两个低SBP组在目标剂量达成情况和结局方面未发现差异。
持续性和隐匿性低SBP在HF患者中很常见，且均与GDMT不耐受和不良结局相关。
