Author + information
- Cynthia A. Jackevicius, BScPhm, PharmD, MSc∗ (, )
- Zunera Ghaznavi, MPH,
- Lingyun Lu, PharmD, MSc and
- Alberta L. Warner, MD
- ↵∗Western University of Health Sciences, College of Pharmacy, 309 East Second Street, Pomona, California 91766
Dr. Guo and colleagues have correctly noted the importance of mitral regurgitation in the prognosis of patients with heart failure (HF). Unfortunately, reliable information for mitral regurgitation in sufficient numbers of patients was not available to perform this analysis.
Concerns that alpha-adrenergic blocker (AB) drugs could lead to symptomatic hypotension or syncope are appropriate, especially considering that agent is combined with HF medications that also have hypotensive effects. However, this study was a study of prevalent not incident use (1). All patients were already receiving alpha-AB at the time of their index hospitalization and, as such, were likely pre-selected because they had been tolerating the drug well. Reasons for any subsequent discontinuation of alpha-AB could not be determined from available data.
As far as HF with preserved ejection fraction (HFpEF) was concerned, the association observed between alpha-AB and improved outcomes in the propensity score-matched cohort was as great or greater in patients with HFpEF than in those with reduced EF. Patients with EF above 40% treated with alpha-AB had a lower incidence of HF admissions (hazard ratio [HR]: 0.95; 95% confidence interval [CI]: 0.92 to 0.98; p = 0.0008; p value for interaction with EF: p = 0.23) and death (HR: 0.90; 95% CI: 0.88 to 0.92; p < 0.0001; p value for interaction with EF: p < 0.0001). This finding is reassuring and merits exploration as a potential therapeutic target in the difficult-to-treat HFpEF population.
Please note: The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- 2019 American College of Cardiology Foundation