Identification and prognosis of low office and ambulatory blood pressure in patients with heart failure

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 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.