title: Efficacy and safety of ivabradine in patients with chronic systolic heart failure according to blood pressure level in SHIFT.
abstract: OBJECTIVE
  Low systolic blood pressure (SBP) is associated with poor outcomes in heart failure and complicates management. In a post hoc analysis, we investigated the efficacy and safety of ivabradine in the SHIFT population divided by tertiles of baseline SBP.
  
  
  RESULTS
  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; P interaction = 0.68]. Similar results were found for cardiovascular mortality (P interaction = 0.91), hospitalization because of heart failure (P interaction = 0.79), all-cause mortality (P interaction = 0.90), and heart failure mortality (P interaction = 0.18). There was no evidence for a difference in safety profile according to SBP group.
  
  
  CONCLUSIONS
  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.
authors: Institute of Cardiometabolism and Nutrition (ICAN), Pierre et Marie Curie Paris VI University, La Pitié-Salpétrière Hospital, Paris, France.
authors: Michel
authors: M
authors: Komajda
authors: Michael
authors: M
authors: Böhm
authors: Jeffrey S
authors: JS
authors: Borer
authors: Ian
authors: I
authors: Ford
authors: Michele
authors: M
authors: Robertson
authors: Athanasios J
authors: AJ
authors: Manolis
authors: Luigi
authors: L
authors: Tavazzi
authors: Karl
authors: K
authors: Swedberg
mesh_terms: D000368:Aged; D001552:Benzazepines / Q000627:therapeutic use*; D001794:Blood Pressure / Q000502:physiology*; D002317:Cardiovascular Agents / Q000627:therapeutic use*; D004311:Double-Blind Method; D005260:Female; D054143:Heart Failure, Systolic / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D006801:Humans; D006973:Hypertension / Q000150:complications; D007022:Hypotension / Q000150:complications; D000077550:Ivabradine; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D013599:Systole; D016896:Treatment Outcome
chemical_list: D001552:Benzazepines; D002317:Cardiovascular Agents; D000077550:Ivabradine
keywords: Blood pressure; Ivabradine; Outcomes; SHIFT; Systolic heart failure