From the Research
The average blood pressure in patients with Heart Failure (HF) with reduced Left Ventricular (LV) Ejection Fraction (EF) is typically lower than standard hypertension goals, with an optimal range of 110-130 mmHg systolic and 60-80 mmHg diastolic, as supported by the most recent study in 2023 1.
Background
Heart failure with reduced ejection fraction (HFrEF) is a condition where the heart is unable to pump enough blood to meet the body's needs, resulting in symptoms such as shortness of breath, fatigue, and swelling. Blood pressure management is crucial in patients with HFrEF, as excessive blood pressure can increase cardiac workload and worsen heart failure symptoms.
Blood Pressure Management
The medications used to treat HFrEF, including ACE inhibitors (like lisinopril, enalapril), ARBs (such as valsartan, losartan), beta-blockers (metoprolol succinate, carvedilol, bisoprolol), and SGLT2 inhibitors (dapagliflozin, empagliflozin), all have blood pressure-lowering effects. When initiating or titrating these medications, blood pressure should be monitored closely, especially in patients with baseline lower pressures. The goal is to optimize heart failure therapy while maintaining adequate blood pressure for perfusion.
Optimal Blood Pressure Range
The optimal blood pressure range for patients with HFrEF is typically lower than standard hypertension goals, with a range of 110-130 mmHg systolic and 60-80 mmHg diastolic. This range is supported by the most recent study in 2023 1, which found that conventional guideline-directed medical therapy (GDMT) use was associated with decreased adverse outcomes in most patients with HF compounded by systolic dysfunction and low BP.
Considerations
However, blood pressure should not be lowered too aggressively, as hypotension (systolic BP below 90 mmHg) can compromise organ perfusion and lead to dizziness, falls, and worsened renal function. If a patient consistently has low blood pressure that limits optimization of heart failure medications, consultation with a cardiologist is recommended to determine the best approach for that individual.
Key Points
- The average blood pressure in patients with HFrEF is typically lower than standard hypertension goals.
- The optimal blood pressure range for patients with HFrEF is 110-130 mmHg systolic and 60-80 mmHg diastolic.
- Blood pressure should be monitored closely when initiating or titrating medications for HFrEF.
- The goal is to optimize heart failure therapy while maintaining adequate blood pressure for perfusion.
- Consultation with a cardiologist is recommended if a patient consistently has low blood pressure that limits optimization of heart failure medications, as supported by studies such as 2, 3, and 4.