{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,10]],"date-time":"2026-11-10T06:57:26Z","timestamp":1794293846980,"version":"4.9.0"},"reference-count":132,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2025,2,26]],"date-time":"2025-02-26T00:00:00Z","timestamp":1740528000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"},{"start":{"date-parts":[[2025,2,26]],"date-time":"2025-02-26T00:00:00Z","timestamp":1740528000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,4,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Despite major advancements in heart failure (HF) management and guideline recommendations over the past two decades, real-world evidence highlights suboptimal implementation of guideline-directed medical therapy (GDMT) for HF with reduced ejection fraction (HFrEF). Low blood pressure (BP) is common in HFrEF patients and represents a major perceived barrier to implementing life-saving treatments in clinical practice, as physicians are often concerned about symptomatic hypotension and its consequences. Although low BP can be seen in those hospitalized with signs of shock, the most common scenario involves non-severe, asymptomatic hypotension in patients receiving foundational therapy for HFrEF, where premature down-titration or discontinuation of GDMT should be avoided. This clinical consensus statement provides a comprehensive overview of low BP in HFrEF, including its definition, risk factors, and effects of HF therapies on BP. We propose management pathways to optimize HFrEF treatment in the context of low BP, ultimately aiming to improve patient outcomes.<\/jats:p>","DOI":"10.1002\/ejhf.3618","type":"journal-article","created":{"date-parts":[[2025,3,8]],"date-time":"2025-03-08T02:46:56Z","timestamp":1741402016000},"page":"707-722","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":53,"title":["Clinical Management and Therapeutic Optimization of Patients with Heart Failure with Reduced Ejection Fraction and Low Blood Pressure. A Clinical Consensus Statement of the Heart Failure Association (HFA) of the ESC"],"prefix":"10.1093","volume":"27","author":[{"given":"Hadi","family":"Skouri","sequence":"first","affiliation":[{"name":"Division of Cardiology, Balamand University Faculty of Medicine , Beirut ,","place":["Lebanon"]},{"name":"Division of Cardiology, Sheikh Shakhbout Medical City , Abu-Dhabi ,","place":["UAE"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicolas","family":"Girerd","sequence":"additional","affiliation":[{"name":"Universit\u00e9 de Lorraine, Centre d'Investigations Cliniques Plurith\u00e9matique 1433 and Inserm U1116, CHRU Nancy, FCRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists) , Nancy ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luca","family":"Monzo","sequence":"additional","affiliation":[{"name":"Universit\u00e9 de Lorraine, Centre d'Investigations Cliniques Plurith\u00e9matique 1433 and Inserm U1116, CHRU Nancy, FCRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists) , Nancy ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark C.","family":"Petrie","sequence":"additional","affiliation":[{"name":"School of Cardiovascular and Metabolic Health, University of Glasgow, British Heart Foundation Glasgow Cardiovascular Research Centre , Glasgow ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"B\u00f6hm","sequence":"additional","affiliation":[{"name":"Universitatsklinikum des Saarlandes, Klinik f\u00fcr Innere Medizin III, Saarland University, Kardiologie, Angiologie und Internistische Intensivmedizin , Homburg ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marianna","family":"Adamo","sequence":"additional","affiliation":[{"name":"Cardiology and Cardiac Catheterization Laboratory, ASST Spedali Civili Brescia and Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia , Brescia ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wilfried","family":"Mullens","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Ziekenhuis Oost-Limburg , Genk ,","place":["Belgium"]},{"name":"UHasselt, Biomedical Research Institute, Faculty of Medicine and Life Sciences, LCRC , Diepenbeek ,","place":["Belgium"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gianluigi","family":"Savarese","sequence":"additional","affiliation":[{"name":"Unit of Cardiology, Department of Medicine, Karolinska Institutet , Stockholm ,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mehmet Birhan","family":"Yilmaz","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Faculty of Medicine, Dokuz Eylul University , Izmir ,","place":["T\u00fcrkiye"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Offer","family":"Amir","sequence":"additional","affiliation":[{"name":"Hadassah Medical Center, Faculty of Medicine, Hebrew University , Jerusalem ,","place":["Israel"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antoni","family":"Bayes-Genis","sequence":"additional","affiliation":[{"name":"Heart Institute, Hospital Universitari Germans Trias i Pujol, CIBERCV , Badalona ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Biykem","family":"Bozkurt","sequence":"additional","affiliation":[{"name":"Cardiology Section, Winters Center for Heart Failure, Baylor College of Medicine , Houston, TX ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Javed","family":"Butler","sequence":"additional","affiliation":[{"name":"Baylor Scott and White Research Institute , Dallas, TX ,","place":["USA"]},{"name":"University of Mississippi , Jackson, MS ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ovidiu","family":"Chioncel","sequence":"additional","affiliation":[{"name":"Emergency Institute for Cardiovascular Diseases \u2018Prof. C.C. Iliescu\u2019, University of Medicine Carol Davila , Bucharest ,","place":["Romania"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandre","family":"Mebazaa","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia-Burn-Critical Care, Universit\u00e9 de Paris, UMR Inserm \u2013 MASCOT; APHP Saint Louis Lariboisi\u00e8re University Hospitals , Paris ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jose L.","family":"Merino","sequence":"additional","affiliation":[{"name":"Arrhythmia & Robotic EP Unit, University Hospital La Paz, Autonoma University, IdiPaz , Madrid ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brenda","family":"Moura","sequence":"additional","affiliation":[{"name":"Armed Forces Hospital, Porto, and Faculty of Medicine of Porto , Porto ,","place":["Portugal"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Piotr","family":"Ponikowski","sequence":"additional","affiliation":[{"name":"Department of Heart Diseases, Wroclaw Medical University , Wroc\u0142aw ,","place":["Poland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Petar","family":"Seferovic","sequence":"additional","affiliation":[{"name":"University Faculty of Medicine, University of Belgrade, and Serbian Academy of Arts and Sciences , Belgrade ,","place":["Serbia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuseppe M.C.","family":"Rosano","sequence":"additional","affiliation":[{"name":"Department of Human Sciences and Promotion of Quality of Life, San Raffaele Open University of Rome , Rome ,","place":["Italy"]},{"name":"Cardiology, San Raffaele Cassino Hospital , Cassino ,","place":["Italy"]},{"name":"IRCCS San Raffaele Roma , Roma ,","place":["Italy"]},{"name":"Cardiology Clinical Academic Group, Molecular and Clinical Sciences Research Institute, City St George's, University of London , London ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Metra","sequence":"additional","affiliation":[{"name":"Cardiology and Cardiac Catheterization Laboratory, ASST Spedali Civili Brescia and Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia , Brescia ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,2,26]]},"reference":[{"key":"2026080801424458300_ejhf3618-bib-0001","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1002\/ejhf.2333","article-title":"2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: Developed by the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). 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