title: Influence of systolic blood pressure on clinical outcomes in elderly heart failure patients treated with nebivolol: data from the SENIORS trial.
abstract: OBJECTIVE
  There is limited information about the effects of beta-blockers in heart failure (HF) stratified by blood pressure, especially in the elderly and those with preserved EF. We evaluate the effects of nebivolol on outcomes in elderly patients with HF stratified by baseline systolic blood pressure (SBP) and EF.
  
  
  RESULTS
  The SENIORS trial evaluated the effects of nebivolol and enrolled 2128 patients ≥ 70 years of age with HF. Patients were divided into three baseline pre-treatment SBP categories (<110, 110-130, and >130 mmHg). In addition, we evaluated the influence of SBP (≤ 130 and > 130 mmHg) on patients with LVEF <40% vs. ≥ 40%. Low baseline SBP was associated with worse clinical outcomes irrespective of treatment group, both in patients with reduced EF and in those with preserved EF. Nebivolol had similar benefits irrespective of baseline SBP: the hazard ratio (HR) for primary outcome of all-cause mortality or cardiovascular hospitalization in the three SBP categories for nebivolol vs. placebo was 0.85 [95% confidence interval (CI) 0.50-1.45], 0.79 (95% CI 0.61-1.01), and 0.88 (95% CI 0.72-1.07), respectively (P for interaction = 0.61). Similar results were obtained for the secondary endpoint of all-cause mortality. There was no significant interaction for the effects of nebivolol by baseline SBP stratified by LVEF.
  
  
  CONCLUSIONS
  Elderly HF patients with lower SBP have a worse outcome than those with higher SBP, but nebivolol appears to be safe and well tolerated, with similar benefits on the composite outcome of death or cardiovascular hospital admission irrespective of baseline SBP and LVEF.
authors.affiliation: Department of Internal Medicine, IMIBIC/Hospital Reina Sofia de Córdoba, University of Córdoba, Spain.
authors.forename: Manuel
authors.initials: M
authors.lastname: Montero-Perez-Barquero
authors.forename: Marcus
authors.initials: M
authors.lastname: Flather
authors.forename: Michael
authors.initials: M
authors.lastname: Roughton
authors.forename: Andrew
authors.initials: A
authors.lastname: Coats
authors.forename: Michael
authors.initials: M
authors.lastname: Böhm
authors.forename: Dirk J
authors.initials: DJ
authors.lastname: Van Veldhuisen
authors.forename: Daphne
authors.initials: D
authors.lastname: Babalis
authors.forename: Alain Cohen
authors.initials: AC
authors.lastname: Solal
authors.forename: Luis
authors.initials: L
authors.lastname: Manzano
mesh_terms: D058671:Adrenergic beta-1 Receptor Antagonists / Q000008:administration & dosage; D000368:Aged; D001578:Benzopyrans / Q000008:administration & dosage*; D001794:Blood Pressure / Q000187:drug effects* / Q000502:physiology; D004305:Dose-Response Relationship, Drug; D004983:Ethanolamines / Q000008:administration & dosage*; D005060:Europe / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000188:drug therapy / Q000401:mortality / Q000503:physiopathology*; D006801:Humans; D008297:Male; D000068577:Nebivolol; D010975:Platelet Aggregation Inhibitors; D015996:Survival Rate / Q000639:trends; D013599:Systole; D016896:Treatment Outcome
chemical_list: D058671:Adrenergic beta-1 Receptor Antagonists; D001578:Benzopyrans; D004983:Ethanolamines; D010975:Platelet Aggregation Inhibitors; D000068577:Nebivolol
keywords: Beta-blockers; Blood pressure; Elderly; Heart failure; Prognosis