title: Current management and future directions for the treatment of patients hospitalized for heart failure with low blood pressure.
abstract: Although patients hospitalized with heart failure have relatively low in-hospital mortality, the post-discharge rehospitalization and mortality rates remain high despite advances in treatment. Most patients admitted for heart failure have normal or high blood pressure, but 15-25 % have low systolic blood pressure with or without signs and/or symptoms of hypoperfusion. All pharmacological agents known to improve the prognosis of patients with heart failure also reduce blood pressure, and this limits their use in patients with heart failure and low blood pressure (HF-LBP). However, patients with HF-LBP have much higher in-hospital and post-discharge mortality. In these patients, a conceptually important therapeutic target is to improve cardiac output in order to alleviate signs of hypoperfusion. Accordingly, the majority of these patients will require an inotrope as cardiac dysfunction is the cause of their low cardiac output. However, the short-term use of currently available inotropes has been associated with further decreases in blood pressure and increases in heart rate, myocardial oxygen consumption and arrhythmias. Agents that improve cardiac contractility without this undesirable effects should be developed. To the best of our knowledge, the epidemiology, pathophysiology and therapy of patients with HF-LBP have not been addressed thoroughly. In June 2010, a workshop that included scientists and clinicians was held in Rome, Italy. The objectives of this meeting were to (1) develop a working definition for HF-LBP, (2) describe its clinical characteristics and pathophysiology, (3) review current therapies and their limitations, (4) discuss novel agents in development and (5) create a framework for the design and conduct of future clinical trials.
authors.affiliation: Center of Cardiovascular Innovation, Northwestern University Feinberg School of Medicine, 645 North Michigan Ave, Suite 1006, Chicago, IL 60611, USA. m-gheorghiade@northwestern.edu
authors.forename: Mihai
authors.initials: M
authors.lastname: Gheorghiade
authors.forename: Muthiah
authors.initials: M
authors.lastname: Vaduganathan
authors.forename: Andrew
authors.initials: A
authors.lastname: Ambrosy
authors.forename: Michael
authors.initials: M
authors.lastname: Böhm
authors.forename: Umberto
authors.initials: U
authors.lastname: Campia
authors.forename: John G F
authors.initials: JG
authors.lastname: Cleland
authors.forename: Francesco
authors.initials: F
authors.lastname: Fedele
authors.forename: Gregg C
authors.initials: GC
authors.lastname: Fonarow
authors.forename: Aldo P
authors.initials: AP
authors.lastname: Maggioni
authors.forename: Alexandre
authors.initials: A
authors.lastname: Mebazaa
authors.forename: Mandeep
authors.initials: M
authors.lastname: Mehra
authors.forename: Marco
authors.initials: M
authors.lastname: Metra
authors.forename: Savina
authors.initials: S
authors.lastname: Nodari
authors.forename: Peter S
authors.initials: PS
authors.lastname: Pang
authors.forename: Piotr
authors.initials: P
authors.lastname: Ponikowski
authors.forename: Hani N
authors.initials: HN
authors.lastname: Sabbah
authors.forename: Michel
authors.initials: M
authors.lastname: Komajda
authors.forename: Javed
authors.initials: J
authors.lastname: Butler
mesh_terms: D000368:Aged; D001794:Blood Pressure / Q000187:drug effects*; D015897:Comorbidity; D003226:Congresses as Topic; D019468:Disease Management; D005260:Female; D006333:Heart Failure / Q000188:drug therapy* / Q000401:mortality / Q000503:physiopathology; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007022:Hypotension / Q000188:drug therapy* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012384:Rome; D016896:Treatment Outcome