{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T14:16:09Z","timestamp":1787667369052,"version":"build-2736575974"},"reference-count":20,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2025,2,20]],"date-time":"2025-02-20T00:00:00Z","timestamp":1740009600000},"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":[[2025,2,20]],"date-time":"2025-02-20T00:00:00Z","timestamp":1740009600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100019718","name":"Boehringer Ingelheim","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100019718","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100019718","name":"Boehringer Ingelheim Espa\u00f1a","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100019718","id-type":"DOI","asserted-by":"publisher"}]}],"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:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Empagliflozin improves outcomes in acute heart failure (AHF). Patients with AHF and low blood pressure (BP) have poor prognosis. Whether empagliflozin is effective and safe in patients with AHF and low BP is currently unknown. The aim of this study was to assess the efficacy and safety of empagliflozin (vs. placebo) in patients with low BP \u2013 either systolic BP (SBP)\u2009&amp;lt;110\u2009mmHg or diastolic BP (DBP)\u2009&amp;lt;70\u2009mmHg \u2013 at randomization.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>EMPULSE included 530 patients with AHF followed for 90\u2009days. The primary outcome was a hierarchical composite of all-cause mortality, HF events, and Kansas City Cardiomyopathy Questionnaire total symptom score changes at 90\u2009days tested using the win ratio (WR). Patients were required to have SBP \u2265100\u2009mmHg for randomization. A total of 131 (25%) patients had SBP\u2009&amp;lt;110\u2009mmHg and 190 (36%) DBP\u2009&amp;lt;70\u2009mmHg. In placebo, low BP was associated with more clinical and adverse events. Compared to placebo, BP changes with empagliflozin were of small magnitude (\u22122 to 2\u2009mmHg), not reaching statistical significance. Patients presenting with low BP increased their BP, on average, throughout the 90-day follow-up, regardless of treatment group. Empagliflozin (vs. placebo) improved clinical outcomes regardless of BP at randomization, potentially with a larger magnitude of effect in patients presenting with low DBP at randomization: primary outcome WR\u2009=\u20091.48, 95% confidence interval (CI) 1.15\u20131.90, p\u2009=\u20090.0025; WR\u2009=\u20091.23, 95% CI 0.94\u20131.60 in DBP \u226570\u2009mmHg and WR\u2009=\u20092.11, 95% CI 1.46\u20133.04 in DBP\u2009&amp;lt;\u200970\u2009mmHg (interaction p\u2009=\u20090.02).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Patients admitted for AHF with low BP had a higher risk of clinical events. Empagliflozin did not lower BP more than placebo and was effective and safe irrespective of BP. Empagliflozin should be considered for the treatment of AHF patients even when presenting with low BP.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ejhf.3626","type":"journal-article","created":{"date-parts":[[2025,2,21]],"date-time":"2025-02-21T02:03:53Z","timestamp":1740103433000},"page":"671-680","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Low Blood Pressure and the Effect of Empagliflozin in Acute Heart Failure: An EMPULSE Analysis"],"prefix":"10.1093","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2304-6138","authenticated-orcid":false,"given":"Jo\u00e3o Pedro","family":"Ferreira","sequence":"first","affiliation":[{"name":"Universit\u00e9 de Lorraine, Inserm, Centre d'Investigations Cliniques, \u2013 Plurith\u00e9matique 14-33, Inserm U1116, CHRU Nancy, F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists) , Nancy ,","place":["France"]},{"name":"Cardiovascular R&D Centre (UnIC); Department of Surgery and Physiology, Faculty of Medicine of the University of Porto , Porto ,","place":["Portugal"]},{"name":"Heart Failure Clinic, Unidades Locais de Sa\u00fade de Gaia\/Espinho & S\u00e3o Jo\u00e3o , Porto ,","place":["Portugal"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francisco","family":"Vasques-N\u00f3voa","sequence":"additional","affiliation":[{"name":"Cardiovascular R&D Centre (UnIC); Department of Surgery and Physiology, Faculty of Medicine of the University of Porto , Porto ,","place":["Portugal"]},{"name":"Heart Failure Clinic, Unidades Locais de Sa\u00fade de Gaia\/Espinho & S\u00e3o Jo\u00e3o , Porto ,","place":["Portugal"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christiane E.","family":"Angermann","sequence":"additional","affiliation":[{"name":"Comprehensive Heart Failure Centre, University & University Hospital of W\u00fcrzburg , W\u00fcrzburg ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan","family":"Biegus","sequence":"additional","affiliation":[{"name":"Institute of Heart Diseases, Wroclaw Medical University , Wroclaw ,","place":["Poland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sean P.","family":"Collins","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Vanderbilt University Medical Center and Geriatric Research and Education Clinical Care, Tennessee Valley Healthcare Facility VA Medical Center , Nashville, TN ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mikhail","family":"Kosiborod","sequence":"additional","affiliation":[{"name":"Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City , Kansas City, MS ,","place":["USA"]},{"name":"George Institute for Global Health and the University of New South Wales , Sydney, NSW 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