Efficacy and safety of ivabradine in patients with chronic systolic heart failure according to blood pressure level in SHIFT. (24th June 2014)

• Record Type: Journal Article
• Authors: Komajda, Michel; Böhm, Michael; Borer, Jeffrey S; Ford, Ian; Robertson, Michele; Manolis, Athanasios J.; Tavazzi, Luigi; Swedberg, Karl; on behalf of the SHIFT Investigators
• Is Part Of: European journal of heart failure. Volume 16:Number 7(2014)
• Page Start: 810
• Page End: 816
• Publication Date: 2014-06-24
• Subjects: Heart failure -- Periodicals; Heart Failure -- Periodicals; Insuffisance cardiaque -- Périodiques; Heart failure; Periodicals; 616.129005
• DOI: 10.1002/ejhf.114
• Languages: English
• ISSNs: 1388-9842

Abstract

<abstract abstract-type="main" id="ejhf114-abs-0001"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="ejhf114-sec-0001" sec-type="section"> <title>Aims</title> <p id="ejhf114-para-0001">Low systolic blood pressure (SBP) is associated with poor outcomes in heart failure and complicates management. In a <italic>post hoc</italic> analysis, we investigated the efficacy and safety of ivabradine in the SHIFT population divided by tertiles of baseline SBP.</p> </sec> <sec id="ejhf114-sec-0002" sec-type="section"> <title>Methods and Results</title> <p id="ejhf114-para-0002">The analysis comprised 2110 patients with SBP <115 mmHg, 1968 with 115≤ SBP <130 mmHg, and 2427 with SBP ≥130 mmHg. Patients with low SBP were younger, had lower ejection fraction, and were less likely to be at target beta‐blocker dose than patients in the other SBP groups. Ivabradine was associated with a similar relative risk reduction of the composite outcome in the three SBP groups [SBP <115 mmHg, hazard ratio (HR) = 0.84, 95% confidence interval (CI) 0.72–0.98; 115≤ SBP <130 mmHg, HR = 0.86, 95% CI 0.72 to 1.03; SBP ≥130 mmHg, HR = 0.77, 95% CI 0.66 to 0.92; <italic>P</italic> interaction = 0.68]. Similar results were found for cardiovascular mortality (<italic>P</italic> interaction = 0.91), hospitalization because of heart failure (<italic>P</italic> interaction = 0.79), all‐cause mortality (<italic>P</italic> interaction = 0.90), and heart failure mortality (<italic>P</italic> interaction = 0.18). There was no evidence for a difference in safety profile according to SBP group.</p> </sec> <sec id="ejhf114-sec-0003" sec-type="section"> <title>Conclusion</title> <p id="ejhf114-para-0003">The efficacy and safety of ivabradine is independent of SBP. This may have implications for the management of HF patients with low SBP and elevated heart rate.</p> </sec> </abstract>