Empagliflozin, Irrespective of Blood Pressure, Improves Outcomes in Heart Failure with Preserved Ejection Fraction: the EMPEROR-Preserved Trial
Eur Heart J. 2022; online ahead of print DOI: 10.1093/eurheartj/ehac693
Results from EMPEROR-Preserved demonstrated that empagliflozin improved CV and renal outcomes in patients with HFpEF, but its efficacy and safety with baseline SBP is not well established.
In a secondary analysis of EMPEROR-Preserved, the placebo-corrected decline in SBP was small over a median of 26.2 months and not significantly different across baseline SBP. Rates of the primary outcome of CV death or HF hospitalisation were higher at low SBP (<110 mmHg), but the effects of empagliflozin on HF outcomes were not significantly related to baseline SBP. For empagliflozin vs placebo, baseline SBP did not meaningfully associate with AEs, including hypotension, volume depletion and acute renal failure. This analysis indicates that a low SBP should not be a barrier for treatment initiation with empagliflozin in HF patients with LVEF >40%