The Impact of Glucocorticoid Therapy on Guideline-Directed Medical Treatment Titration in Patients Hospitalized for Heart Failure with Low Blood Pressure: A Retrospective Study

Figures & data

Table 1 Demographic and Clinical Characteristics of the Study Population Overall and Stratified by Systolic Blood Pressure Systolic Blood Pressure

	Total (n=144)	100mmHg≤BP<110mmHg (n=47)	90≤BP<100mmHg (n=62)	BP<90mmHg (n=35)	P value
Demographic characteristics
Age	52.00 (38.25–65)	50.40±16.92	50.07±18.26	51.80±14.05	0.885
Gender
Male	108(75.0)	39 (83.0)	45 (72.6)	24 (68.6)	0.278
Female	36 (25.0)	8 (17.0)	17 (27.4)	11 (31.4)	0.278
Etiology
ICM	18 (12.4)	7 (14.9)	7 (11.4)	4 (11.3)	0.677
DCM	106 (73.6)	33 (70.2)	47 (75.8)	26 (74.3)	0.677
VHD	7 (4.9)	4 (8.5)	2 (3.2)	1 (2.9)	0.677
HCM	5 (3.5)	2 (4.3)	1 (1.6)	2 (5.7)	0.677
PPCM	3 (2.1)	0 (0.0)	2 (3.2)	1 (2.9)	0.677
Other Causes	5 (3.5)	1 (2.1)	3 (4.8)	1 (2.9)	0.677
SBP (mmHg)	94.49 (93.09–95.89)	103.51 (102.57–104.45)	94.24 (93.53–94.96)	82.80 (81.17–84.43)	0.000
DBP (mmHg)	63.40 (61.92–64.87)	66.77 (63.71–69.82)	64.47 (62.86–66.08)	56.97 (54.35–59.59)	0.000
HR	74.50 (66.00–82.00)	75.87±13.41	75.55±13.47	78.00±16.60	0.702
Diuretic response (mL/40mg furosemide)	776.7 (133.8–2000)	791.5 (582.3–1700)	1200 (400–3100)	785 (388.3–1988)	0.395
Laboratory Results
BUN (mg/dl)	45.44 (34.2–65.57)	49.64 (34.26–77.71)	43.03 (32.27–56.97)	45.44 (36.36–68.03)	0.199
SCr (mg/dl)	1.03 (0.89–1.26)	1.05 (0.96–1.26)	1.02 (0.83–1.22)	1.06 (0.83–1.26)	0.240
Echocardiography
LVEF (%)	28.92±8.059	29.85±8.681	28.26±7.756	28.83±7.812	0.601
LVED (mm)	70.50 (65.00–76.00)	72.00 (70.00–77.00)	69.00 (65.00–76.00)	69.00(62.00–76.00)	0.429
Medication
β-blocks	121 (84.0)	36 (76.6)	54 (87.1)	31 (88.6)	0.234
ACEI/ARB/ARNI	59 (41.0)	18 (38.3)	26 (41.9)	15 (42.9)	0.898
Intravenous Inotrope	21 (14.6)	6 (12.8)	5 (8.1)	10 (28.6)	0.021
Loop Diuretic	140 (97.2)	45 (95.7)	61 (98.4)	34 (97.1)	0.707

Abbreviations: ICM, ischemic cardiomyopathy; DCM, dilated cardiomyopathy; VHD, valvular heart disease; HCM, hypertrophic cardiomyopathy; PPCM, peripartum cardiomyopathy; SBP, systolic blood pressure; DBP, diastolic blood pressure; HR, heart rate; BUN, blood urea nitrogen; SCr, serum creatinine; LVEF, left ventricular ejection fraction; LVED, left ventricular end-diastolic diameter; ACEI, angiotensin-converting enzyme inhibitors; ARB, angiotensin receptor blockers; ARNI; angiotensin receptor neprilysin inhibitor.

Figure 1 Clinical outcomes according to the use of glucocorticoids over 28 days among HF-LBP patients. (A) Change in dose of metoprolol; (B) change in dose of captopril; (C) change in SBP; (D) change in DBP; (E) change in heart rate; (F) change in EF; (G) change from baseline to the 7th day in urine volume; (H) change in SCr; (I) change in diuretic response. ^#Compared with baseline, P < 0.05; ^$Compared with the 7th day, P < 0.05; ^&Compared with the 14th day, P < 0.05; ^#Compared with the baseline, P < 0.05; ^$Compared with the 2nd day, P < 0.05; ^&Compared with the 3rd day, P < 0.05; *Compared with the 4th day, P < 0.05; ^ΔCompared with the 5th day, P < 0.05.

Figure 2 Subgroup analysis of clinical outcomes according to the use of glucocorticoids over 28 days among HF-LBP patients. (A) Change in dose of metoprolol; (B) change in dose of captopril; (C) change in SBP; (D) change in DBP; (E) change in heart rate; (F) change in EF; (G) change from baseline to the 7th day in urine volume; (H) change in SCr; (I) change in diuretic response. 100 ≤ BP < 110: upper tertile BP group; 90 ≤ BP < 100: medium tertile BP group; BP < 90: lower tertile BP group. ^#Compared with baseline, P < 0.05; ^$Compared with the 7th day, P < 0.05; &Compared with the 14th day, P < 0.05; ^#Compared with the baseline, P < 0.05; ^$Compared with the 2nd day, P < 0.05; ^&Compared with the 3rd day, P < 0.05; *Compared with the 4th day, P < 0.05; ^ΔCompared with the 5th day, P < 0.05.