Physicians' Academy for Cardiovascular Education

No interaction between SBP and effects of SGLT2i on outcomes in HFrEF

Empagliflozin improves cardiovascular and renal outcomes in heart failure irrespective of systolic blood pressure

Literature - Böhm M, Anker SD, Butler J et al. - J Am Coll Cardiol 2021; 78:1337-48,

Introduction and methods

Aim of the study

Studies have reported that SGLT2 inhibitors reduce systolic blood pressure (SBP) in patients with diabetes and hypertension [1,2]. Therefore, these heart failure medications are often not prescribed or are used at low doses in patients with a low SBP [3,4]. But HFrEF patients with the lowest SBP are at the highest risk of CV death and hospitalization for HF [5] and may not be likely to receive SGLT2i treatment. This analysis of the EMPEROR-Reduced trial examined the effect of baseline SBP on efficacy of empagliflozin in HFrEF patients with a focus on patients with the lowest SBP.

Study design

In the EMPEROR-Reduced trial, 3730 HFrEF patients with or without diabetes were randomized double-blind to receive placebo or empagliflozin in addition to standard therapy for heart failure. BP was measured at the screening visit and subsequent visits using a standard manometer at the same arm in a sitting position after 5 min of rest. The mean of 3 measurements was used.

For this analysis, patients were grouped according to baseline SBP: <110 mgHg, 110-130 mmHg and >130 mmHg.

Primary outcome

Primary outcome was the time to first event of the composite of adjudicated CV death or hospitalization for HF.

Main results


In patients with HFrEF in the EMPEROR-Reduced trial, the SGLT2 inhibitor empagliflozin reduced the risk of the primary endpoint, HF hospitalization and renal outcomes independently of baseline SBP. Empagliflozin treatment was well tolerated in patients in the low SBP group (<110 mmHg) and these patients had no decline in SBP and no increased risk of hypotension.


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Find this article online at J Am Coll Cardiol

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