Physicians' Academy for Cardiovascular Education

Effect of SGLT2 inhibitor on CV death or HF hospitalization in HFpEF independent of SBP

Empagliflozin, irrespective of blood pressure, improves outcomes in heart failure with preserved ejection fraction: the EMPEROR-Preserved trial

Literature - Böhm M, Anker S, Mahfoud S, et al. - Eur Heart J. 2022 Dec 7;ehac693. doi: 10.1093/eurheartj/ehac693.

Introduction and methods


The EMPEROR-Preserved trial previously showed that the SGLT2 inhibitor empagliflozin reduces the risk of cardiovascular death or first hospitalization for HF in patients with HF and an LVEF >40% (HFpEF), compared with placebo [1]. It is unclear whether this effect is modified by SBP.

Aim of the study

This secondary post-hoc analysis of the EMPEROR-Preserved trial examined whether the effect of empagliflozin in patients with HFpEF is modified by SBP.


In the international, multicenter, double-blind EMPEROR-Preserved trial, 5988 adult patients with chronic HF and an LVEF >40% were randomized to empagliflozin or placebo, in addition to usual therapy. Patients with NYHA class II-IV symptoms and a NT-proBNP level >300 pg/mL who had been hospitalized for HF in the past 12 months or in whom structural abnormalities were found on echocardiography were eligible to participate in this phase 3 study. BP was taken in a sitting position after 5 min of rest. The mean of three attended BP measurements was calculated. In this secondary post-hoc analysis, patients were divided into 3 groups based on their SBP at study entry: <110 mmHg (n=455); 110-130 mmHg (n=2415); and >130 mmHg (n=3118).


The primary outcome was a composite of the time to cardiovascular death or first hospitalization for HF. Secondary outcomes were time to first and recurrent hospitalization for HF and the change in eGFR slope (in mL/min per 1.73 m2 per year). Also examined were the effect of empagliflozin on blood pressure and adverse events.

Main results


This secondary post-hoc analysis of the placebo-controlled EMPEROR-Preserved trial shows that empagliflozin significantly improves the time to cardiovascular death or first hospitalization for HF in patients with HFpEF, independent of SBP.


Show references

Find this article online at Eur Heart J.

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