Physicians' Academy for Cardiovascular Education

SGLT2 inhibitor improves CV outcomes in HFrEF patients independent of SBP

Effect of dapagliflozin according to baseline systolic blood pressure in the Dapagliflozin and Prevention of Adverse Outcomes in Heart Failure trial (DAPA-HF)

Literature - Serenelli M, Böhm M, Inzucchi SE, et al. - Eur Heart J, doi: 10.1093/eurheartj/ehaa496.

Introduction and methods

HF patients with reduced ejection fraction (HFrEF) have reduced cardiac output, which can result in lower systolic blood pressure (SBP) and increased risk of adverse events [1-5]. Most beneficial therapies for HFrEF reduce SBP, but HFrEF patients with lower SBP have increased risk of adverse events compared to patients with a higher SBP. Also concerns about hypotension lead to underuse of beneficial medication, which worsen clinical outcomes [6,7]. SGLT2 inhibitors are recommended in diabetes patients with HF and have been shown to reduce the risk of HF hospitalization and lower baseline SBP in T2DM patients by 3-4 mm Hg [8,9].

This subanalysis of the Dapagliflozin and Prevention of Adverse Outcome in Heart Failure (DAPA-HF) trial in HFrEF patients assessed the effect of the SGLT2 inhibitor dapagliflozin on SBP and the efficacy and safety according to baseline SBP.

The DAPA-HF trial was a randomized, double-blind, placebo-controlled, event-driven, trial in HFrEF patients (NYHA Class II to IV, LVEF ≤40%, and NTproBNP ≥600 pg/mL [≥400 pg/mL if hospitalized due to HF in the last 12 months, or ≥900 pg/mL in patients with AF or atrial flutter irrespective of history of HF hospitalization]). Main exclusion criteria included SBP <95 mm Hg or symptoms of hypotension, estimated glomerular filtration rate (eGFR) <30 mL/min/1.73m² or rapidly declining kidney function, or T1DM. A total of 4744 patients were randomly assigned to receive, in addition to their standard medication, 10 mg dapagliflozin or placebo daily. The primary outcome was the composite of an episode of worsening HF (urgent visit due to HF or hospitalization) or CV death. In this subanalysis of the DAPA-HF trial, patients were subdivided into four baseline SBP groups: <110 mm Hg (n=1205), ≥110 to <120 mm Hg (n=981), ≥120 to <130 mm Hg (n=1149), and ≥130 mm Hg (n=1409). SBP was measured at 14, 60, 120, 240, and 360 days, and every 4 months thereafter.

Main results


HFrEF patients in the DAPA-HF trial receiving 10 mg of dapagliflozin daily showed improved CV outcome compared to the placebo group, independent of SBP.


Show references

Find this article online at Eur Heart J.

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