{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T00:28:25Z","timestamp":1791851305299,"version":"4.3.4"},"reference-count":24,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2025,12,5]],"date-time":"2025-12-05T00:00:00Z","timestamp":1764892800000},"content-version":"vor","delay-in-days":745,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2023,11,21]],"date-time":"2023-11-21T00:00:00Z","timestamp":1700524800000},"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":[[2024,2,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Heart failure (HF) medication may reduce blood pressure (BP). Low BP is associated with worse outcomes but how this association is modified by HF medication has not been studied. We evaluated the association between BP and outcomes according to HF medication dose in HF with reduced ejection fraction (HFrEF).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>We studied HFrEF patients from the Swedish HF registry (2000\u20132018). Associations between systolic BP (SBP) and cardiovascular death (CVD) and\/or HF hospitalization (HFH) were analysed according to doses of renin\u2013angiotensin system (RAS) inhibitors, beta-blockers and mineralocorticoid receptor antagonists (MRA). Among 42\u2009040 patients (median age 74.0), lower baseline SBP was associated with higher risk of CVD\/HFH (adjusted hazard ratio [HR] per 10\u2009mmHg higher SBP: 0.92, 95% confidence interval [CI] 0.92\u20130.93), which was less high risk under optimized RAS inhibitor and beta-blocker doses (10% decrease in event rates per 10\u2009mmHg SBP increase in untreated patients vs. 7% decrease in patients at maximum dose, both adjusted p\u2009&amp;lt;\u20090.02). Among the 13\u2009761 patients with repeated measurements, 9.9% reported a SBP decrease &amp;gt;10\u2009mmHg when HF medication doses were increased, whereas 24.6% reported a SBP decrease &amp;gt;10\u2009mmHg with stable\/decreasing doses. Decreasing SBP was associated with higher risk of CVD\/HFH in patients with stable (HR 1.10, 95% CI 1.04\u20131.17) or decreasing (HR 1.29, 95% CI 1.18\u20131.42) HF medication dose but not in patients with an increase in doses (HR 0.94, 95% CI 0.86\u20131.02).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The association of lower SBP with higher risk of CVD\/HFH is attenuated in patients with optimized HF medication. These results suggest that low or declining SBP should not limit HF medication optimization.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ejhf.3066","type":"journal-article","created":{"date-parts":[[2023,10,26]],"date-time":"2023-10-26T05:46:46Z","timestamp":1698299206000},"page":"359-369","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":26,"title":["Hypotension in Heart Failure is Less Harmful if Associated with High or Increasing Doses of Heart Failure Medication: Insights from the Swedish Heart Failure Registry"],"prefix":"10.1093","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3278-2057","authenticated-orcid":false,"given":"Nicolas","family":"Girerd","sequence":"first","affiliation":[{"name":"Universit\u00e9 de Lorraine, Inserm, Centre d'Investigations Cliniques-1433, and Inserm U1116, CHRU Nancy, F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists) , Nancy ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefano","family":"Coiro","sequence":"additional","affiliation":[{"name":"Cardiology Department, Santa Maria della Misericordia Hospital , Perugia ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lina","family":"Benson","sequence":"additional","affiliation":[{"name":"Unit of Cardiology, Department of Medicine, Karolinska Institutet , Stockholm ,","place":["Sweden"]},{"name":"Heart and Vascular Theme, Karolinska University Hospital , Stockholm ,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gianluigi","family":"Savarese","sequence":"additional","affiliation":[{"name":"Unit of Cardiology, Department of Medicine, Karolinska Institutet , Stockholm ,","place":["Sweden"]},{"name":"Heart and Vascular Theme, Karolinska University Hospital , Stockholm ,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ulf","family":"Dahlstr\u00f6m","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Department of Health, Medicine and Caring Sciences, Link\u00f6ping University , Link\u00f6ping ,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick","family":"Rossignol","sequence":"additional","affiliation":[{"name":"Universit\u00e9 de Lorraine, Inserm, Centre d'Investigations Cliniques-1433, and Inserm U1116, CHRU Nancy, F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists) , Nancy ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lars H.","family":"Lund","sequence":"additional","affiliation":[{"name":"Unit of Cardiology, Department of Medicine, Karolinska Institutet , Stockholm ,","place":["Sweden"]},{"name":"Heart and Vascular Theme, Karolinska University Hospital , Stockholm ,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2023,11,21]]},"reference":[{"key":"2026010913042990900_ejhf3066-bib-0001","doi-asserted-by":"crossref","first-page":"503","DOI":"10.1002\/ejhf.496","article-title":"Use of evidence-based therapy and survival in heart failure in Sweden 2003-2012","volume":"18","author":"Thorvaldsen","year":"2016","journal-title":"Eur J Heart Fail"},{"key":"2026010913042990900_ejhf3066-bib-0002","doi-asserted-by":"crossref","first-page":"317","DOI":"10.1016\/j.cardfail.2019.04.015","article-title":"Increasing complexity of heart failure therapy requires earlier and more frequent referral","volume":"25","author":"Lund","year":"2019","journal-title":"J Card Fail"},{"key":"2026010913042990900_ejhf3066-bib-0003","doi-asserted-by":"crossref","first-page":"514","DOI":"10.1002\/ejhf.510","article-title":"Physicians' adherence to guideline-recommended medications in heart failure with reduced ejection fraction: Data from the QUALIFY global survey","volume":"18","author":"Komajda","year":"2016","journal-title":"Eur J Heart Fail"},{"key":"2026010913042990900_ejhf3066-bib-0004","doi-asserted-by":"crossref","first-page":"1173","DOI":"10.1093\/eurjhf\/hft134","article-title":"Are hospitalized or ambulatory patients with heart failure treated in accordance with European Society of Cardiology guidelines? 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