Journal article
Management of blood pressure in heart failure
- Abstract:
- Hypertension is a common comorbidity in patients with heart failure and most drugs that have demonstrated to improve prognosis in this population have the potential to reduce blood pressure. Nonetheless, the relationship between blood pressure and clinical outcomes and the relevance of blood pressure reduction in heart failure remains unclear. This narrative review summarises the evidence currently available to guide blood pressure treatment in this patient group and highlights key questions for further research. In patients with heart failure with reduced ejection fraction, guidelines consensually recommend treating hypertension with drugs that have compelling indications in heart failure, with a target blood pressure of 130/80 mmHg. In patients with heart failure with preserved ejection fraction, guidelines acknowledge that the optimal treatment strategy remains unclear and thus recommend adopting a similar treatment strategy to patients with reduced ejection fraction. In any case, low blood pressure should not deter uptitration of drugs otherwise indicated to improve prognosis in heart failure, provided that patients tolerate drugs without adverse events. In the absence of evidence for modification of treatment efficacy and safety by baseline blood pressure, it is likely that treatment may actually lead to higher absolute risk reduction in patients with the lowest blood pressure. Special considerations and treatment adjustments are needed in the elderly as well as in patients with diabetes, chronic kidney disease and atrial fibrillation. More evidence is needed on blood pressure management in patients with heart failure in general, in whom the increasing burden of multimorbidity adds further complexity to treatment.
- Publication status:
- Published
- Peer review status:
- Peer reviewed
Actions
Access Document
- Files:
-
-
(Preview, Accepted manuscript, pdf, 238.4KB, Terms of use)
-
(Preview, Accepted manuscript, pdf, 148.8KB, Terms of use)
-
- Publisher copy:
- 10.1136/heartjnl-2018-314438
Authors
- Publisher:
- BMJ Publishing Group
- Journal:
- Heart More from this journal
- Volume:
- 105
- Issue:
- 8
- Pages:
- 589-595
- Publication date:
- 2019-01-23
- Acceptance date:
- 2018-12-21
- DOI:
- EISSN:
-
1468-201X
- ISSN:
-
1355-6037
- Pmid:
-
30674544
- Language:
-
English
- Keywords:
- Pubs id:
-
pubs:966095
- UUID:
-
uuid:df662096-7023-49d5-99de-80e5d6824ff0
- Local pid:
-
pubs:966095
- Source identifiers:
-
966095
- Deposit date:
-
2019-01-28
Terms of use
- Copyright holder:
- Pinho-Gomes and Rahimi
- Copyright date:
- 2019
- Notes:
- This is the accepted manuscript version of the article. The final version is available online from BMJ Publishing Group at: https://doi.org/10.1136/heartjnl-2018-314438
If you are the owner of this record, you can report an update to it here: Report update to this record