{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T00:03:41Z","timestamp":1792109021798,"version":"4.4.0"},"reference-count":52,"publisher":"Oxford University Press (OUP)","issue":"8","license":[{"start":{"date-parts":[[2026,1,18]],"date-time":"2026-01-18T00:00:00Z","timestamp":1768694400000},"content-version":"vor","delay-in-days":2089,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2020,4,30]],"date-time":"2020-04-30T00:00:00Z","timestamp":1588204800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2020,8,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Low blood pressure is common in patients with heart failure and reduced ejection fraction (HFrEF). While spontaneous hypotension predicts risk in HFrEF, there is only limited evidence regarding the relationship between hypotension observed during heart failure (HF) drug titration and outcome. Nevertheless, hypotension (especially orthostatic hypotension) is an important factor limiting the titration of HFrEF treatments in routine practice. In patients with signs of shock and\/or severe congestion, hospitalization is advised. However, in the very frequent cases of non-severe and asymptomatic hypotension observed while taking drugs with a class I indication in HFrEF, European and US guidelines recommend maintaining the same drug dosage. In instances of symptomatic or severe persistent hypotension (systolic blood pressure\u2009&amp;lt;\u200990\u2009mmHg), it is recommended to first decrease blood pressure reducing drugs not indicated in HFrEF as well as the loop diuretic dose in the absence of associated signs of congestion. Unless the management of hypotension appears urgent, a HF specialist should then be sought rather than stopping or decreasing drugs with a class I indication in HFrEF. If symptoms or severe hypotension persist, no recommendations exist. Our HF group reviewed available evidence and proposes certain steps to follow in such situations in order to improve the pharmacological management of these patients.<\/jats:p>","DOI":"10.1002\/ejhf.1835","type":"journal-article","created":{"date-parts":[[2020,4,30]],"date-time":"2020-04-30T15:50:44Z","timestamp":1588261844000},"page":"1357-1365","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":131,"title":["Management of Low Blood Pressure in Ambulatory Heart Failure with Reduced Ejection Fraction Patients"],"prefix":"10.1093","volume":"22","author":[{"given":"Jennifer","family":"Cautela","sequence":"first","affiliation":[{"name":"Heart Failure and Valvular Heart Diseases Unit, Department of Cardiology, Mediterranean University Cardio-Oncology Center (MEDI-CO Center), H\u00f4pital Nord, Aix-Marseille I University , Marseille ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean-Michel","family":"Tartiere","sequence":"additional","affiliation":[{"name":"Cardiology Department, H\u00f4pital Sainte Musse , Toulon ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alain","family":"Cohen-Solal","sequence":"additional","affiliation":[{"name":"CUMR-S 942 MASCOT, Paris University, Cardiology Department, H\u00f4pital Lariboisi\u00e8re, Assistance Publique H\u00f4pitaux de Paris , Paris ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne","family":"Bellemain-Appaix","sequence":"additional","affiliation":[{"name":"Cardiology Department, Centre Hospitalier d\u2019Antibes Juan les Pins , Antibes ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexis","family":"Theron","sequence":"additional","affiliation":[{"name":"Cardio-Thoracic Surgery Department, H\u00f4pital de la Timone , Marseille ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thierry","family":"Tibi","sequence":"additional","affiliation":[{"name":"Cardiology Department, Centre Hospitalier de Cannes , Cannes ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"suffix":"Jr","given":"James L.","family":"Januzzi","sequence":"additional","affiliation":[{"name":"Cardiology Division, Massachusetts General Hospital, Baim Institute for Clinical Research, Harvard Medical School , Boston, MA ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fran\u00e7ois","family":"Roubille","sequence":"additional","affiliation":[{"name":"PhyMedExp, Universit\u00e9 de Montpellier, INSERM, CNRS, Cardiology Department, CHU de Montpellier \u00a0","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicolas","family":"Girerd","sequence":"additional","affiliation":[{"name":"Facult\u00e9 de M\u00e9decine, Universit\u00e9 de Lorraine, Centre d\u2019Investigations Cliniques Plurith\u00e9matique 1433, Institut Lorrain du C\u0153ur et des Vaisseaux, Vandoeuvre les Nancy France Groupe choc, INSERM U1116 , Vandoeuvre les Nancy ,","place":["France"]},{"name":"F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists) , Nancy ,","place":["France"]},{"name":"Cardiology Department, Institut Lorrain du C\u0153ur et des Vaisseaux, CHRU Nancy , Nancy ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2020,4,30]]},"reference":[{"key":"2026011721363759300_ejhf1835-bib-0001","doi-asserted-by":"crossref","first-page":"1429","DOI":"10.1056\/NEJM198706043162301","article-title":"Effects of enalapril on mortality in severe congestive heart failure. 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