Relationship between baseline systolic blood pressure and long-term outcomes in acute heart failure patients treated with TRV027: an exploratory subgroup analysis of BLAST-AHF

Autor: David G. Soergel, Piotr Ponikowski, Gerasimos Filippatos, Javed Butler, Sean P. Collins, Phillip D. Levy, Kathleen Goin, Adriaan A. Voors, G. Michael Felker, Gad Cotter, Stefanie Senger, Beth A. Davison, John R. Teerlink, Peter S. Pang, Justin A. Ezekowitz, David Bharucha, Marco Metra
Přispěvatelé: Cardiovascular Centre (CVC)
Rok vydání: 2017
Předmět:
Male
Time Factors
Blood Pressure
030204 cardiovascular system & hematology
NESIRITIDE
Kidney
chemistry.chemical_compound
0302 clinical medicine
030212 general & internal medicine
RISK
General Medicine
Middle Aged
Treatment Outcome
Acute Disease
Cardiology
Female
Cardiology and Cardiovascular Medicine
Oligopeptides
CLINICAL-TRIALS
Signal Transduction
medicine.drug
medicine.medical_specialty
BLAST-AHF
Blood pressure
Outcomes
Systole
Renal function
Subgroup analysis
Patient Readmission
Receptor
Angiotensin
Type 1
03 medical and health sciences
Internal medicine
medicine
Humans
Aged
Heart Failure
Nesiritide
Creatinine
RECEPTOR
business.industry
MORTALITY
Cardiovascular Agents
WORSENING RENAL-FUNCTION
medicine.disease
Angiotensin II
United States
Clinical trial
chemistry
Heart failure
RELAX-AHF
business
Zdroj: Clinical Research in Cardiology, 107(2), 170-181. SPRINGER HEIDELBERG
ISSN: 1861-0692
1861-0684
DOI: 10.1007/s00392-017-1168-0
Popis: Introduction TRV027, a 'biased' ligand of the angiotensin II type 1 receptor (AT1R), did not affect a composite clinical outcome at 30 days in a phase 2b acute heart failure (AHF) trial (BLAST-AHF).Methods Post-hoc analyses from BLAST-AHF (n = 618) examined the effects of TRV027 by baseline systolic blood pressure (SBP) on changes in renal function and 180-day outcomes. Interactions between baseline SBP and select endpoints were identified utilizing a subpopulation treatment effect pattern plots (STEPP) analysis, then grouping of patients by SBP tertile: = 127 to = 140 mmHg.Results A trend towards increased creatinine in the first 3 days was noted in the lower SBP tertile, while in those in the higher two tertiles, TRV027, especially the 1 mg/h dose, reduced creatinine at days 5 and 30. Beneficial effects on 180-day all-cause mortality and cardiovascular (CV) death or readmission were observed in the two higher SBP tertiles (SBP >= 127 mmHg) in the TRV027 1 mg/h dose group (all-cause mortality HR 0.39, 95% CI 0.14-1.06, p = 0.056; CV death or HF/RF rehospitalization HR 0.53, 95% CI 0.28-1.01, p = 0.049), while more adverse outcomes were observed in patients in the lower SBP tertile.Conclusions This post-hoc analysis of the BLAST-AHF study suggests contrasting effects of TRV027 by baseline SBP, with trends towards lower 180-day event rates in patients enrolled with higher baseline SBP, especially when given lower doses of TRV027.
Databáze: OpenAIRE
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