Low blood pressure and the effect of SGLT2 inhibitors in heart failure with reduced ejection fraction: data from the China Cardiovascular Association Database-Heart Failure Center Registry
Z Qiu, J Bu, Y Chen, Z Li, W Jin, J YangAbstract
Background
Sodium-glucose cotransporter-2 inhibitors (SGLT2i) have become a cornerstone of treatment in heart failure with reduced ejection fraction (HFrEF) management, but data on their use in HFrEF with systolic blood pressure (SBP) lower than 100 mmHg remain limited.
Purpose
To assess the real-world efficacy of SGLT2i in HFrEF patients with low SBP.
Methods
Data were from the China Cardiovascular Association Database-Heart Failure Center Registry between January 1, 2017 to December 31, 2022, which were linked to the National Mortality Registration Information Management System by the Chinese Centre for Disease Control and Prevention. Eligible patients were HFrEF aged 18 years or older with blood pressure, glycated hemoglobin and medication records, and without symptomatic hypotension. The primary outcome was all-cause mortality. A 1:1 propensity score-matched (PSM) analyses and inverse probability of treatment weighting (IPTW) were used to adjust baseline characteristics.
Results
After PSM, 7,476 pairs of patients were included in the SGLT2i and non-SGLT2i groups, of whom median age was 66, 4,744 (31.7%) were female. A total of 2,985 patients had a baseline SBP ≤100 mmHg; 6,871 >100 but ≤120 mmHg; and 5096 >120 mmHg. In non-SGLT2i group, the risk of all-cause death was 12.8 events per 100 patient-years at >120 mmHg, 14.0 at 100-120 mmHg, and 19.2 at ≤100 mmHg. The benefit of SGLT2i on mortality was consistent in patients with low SBP: the HR for SGLT2i vs non-SGLT2i was 0.79 (95% CI: 0.66-0.94) for SBP >120 mmHg, 0.77 (95% CI: 0.66-0.89) for 100<SBP ≤120 mmHg, and 0.77 (95% CI: 0.63-0.93) for SBP ≤100 mmHg. No significant interaction was observed between benefit of SGLT2i use and baseline systolic blood pressure (pinteraction = 0.94). Patients presenting with low SBP experienced an increase in SBP at 1, 3, and 12 months follow-up, regardless treatment group. In the baseline SBP ≤100 mmHg group, a modest between-group reduction in SBP, adjust against the non-SGLT2i control, was observed at 1 month (pinteraction = 0.002) and 3 months (pinteraction = 0.009), but no longer significant at 12 months (pinteraction = 0.456). These outcomes were similar in IPTW analysis including 8,661 patients treated with SGLT2i and 24,876 patients without SGLT2i.
Conclusions
In this nation-wide real-world study, SGLT2i therapy was associated with substantial reductions in mortality across the range of SBP, including those lower than 100mmHg.SGLT2i reduces mortality across all SBP groupChanges of SBP during follow-up