Chronic Systolic Heart Failure, Guideline-Directed Medical Therapy, and Systemic Hypotension-Less Pressure but Maybe More Risk (Does This Clinical Scenario Need More Discussion?)

Wayne L. Miller, Hadi N. Skouri

Research output: Contribution to journalArticle

14 Scopus citations

Abstract

Many clinical trials have demonstrated the survival benefit of medication regimens that modulate the neurohormonal activation that occurs with chronic heart failure (HF). These medications, however, also commonly lower systemic blood pressure (BP). Low arterial BP in patients with chronic HF has been shown to be an independent predictor of increased mortality. Given this apparent paradox in therapeutic goals (treat aggressively but keep BP from going too low), how low should we allow systemic BP to go as a result of our medication regimens before we compromise the proven benefits of such drug therapy? Or is the association between the BP-lowering effects of standard therapy and outcomes in HF even meaningful clinically? It is from this perspective that the merits, potential clinical implications, and the relevant published literature pertaining to this patient and practice management issue will be discussed.

Original languageEnglish (US)
Pages (from-to)101-107
Number of pages7
JournalJournal of Cardiac Failure
Volume15
Issue number2
DOIs
StatePublished - Mar 1 2009

Keywords

  • Heart failure
  • guideline-directed medical therapy
  • outcomes
  • systemic hypotension

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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