Abstract：
Patients with heart failure with reduced ejection fraction and low systolic blood pressure (SBP) have high mortality, hospitalizations, and poorly tolerate evidence-based medical treatment. Omecamtiv mecarbil may be particularly helpful in such patients. This study examined its efficacy and tolerability in patients with SBP ≤100 mmHg enrolled in the Global Approach to Lowering Adverse Cardiac outcomes Through Improving Contractility in Heart Failure (GALACTIC-HF).
The GALACTIC-HF enrolled patients with baseline SBP ≥85 mmHg with a primary outcome of time to cardiovascular death or first heart failure event. In this analysis, patients were divided according to their baseline SBP (≤100 vs. >100 mmHg). Among the 8232 analysed patients, 1473 (17.9%) had baseline SBP ≤100 mmHg and 6759 (82.1%) had SBP >100 mmHg. The primary outcome occurred in 715 (48.5%) and 2415 (35.7%) patients with SBP ≤100 and >100 mmHg, respectively. Patients with lower SBP were at higher risk of adverse outcomes. Omecamtiv mecarbil, compared with placebo, appeared to be more effective in reducing the primary composite endpoint in patients with SBP ≤100 mmHg [hazard ratio (HR), 0.81; 95% confidence interval (CI), 0.70-0.94] compared with those with SBP >100 mmHg (HR, 0.95; 95% CI, 0.88-1.03; P-value for interaction = 0.051). In both groups, omecamtiv mecarbil did not change SBP values over time and did not increase the risk of adverse events, when compared with placebo.
In GALACTIC-HF, risk reduction of heart failure outcomes with omecamtiv mecarbil compared with placebo was large and significant in patients with low SBP. Omecamtiv mecarbil did not affect SBP and was well tolerated independent of SBP values.
The GALACTIC-HF enrolled patients with baseline SBP ≥85 mmHg with a primary outcome of time to cardiovascular death or first heart failure event. In this analysis, patients were divided according to their baseline SBP (≤100 vs. >100 mmHg). Among the 8232 analysed patients, 1473 (17.9%) had baseline SBP ≤100 mmHg and 6759 (82.1%) had SBP >100 mmHg. The primary outcome occurred in 715 (48.5%) and 2415 (35.7%) patients with SBP ≤100 and >100 mmHg, respectively. Patients with lower SBP were at higher risk of adverse outcomes. Omecamtiv mecarbil, compared with placebo, appeared to be more effective in reducing the primary composite endpoint in patients with SBP ≤100 mmHg [hazard ratio (HR), 0.81; 95% confidence interval (CI), 0.70-0.94] compared with those with SBP >100 mmHg (HR, 0.95; 95% CI, 0.88-1.03; P-value for interaction = 0.051). In both groups, omecamtiv mecarbil did not change SBP values over time and did not increase the risk of adverse events, when compared with placebo.
In GALACTIC-HF, risk reduction of heart failure outcomes with omecamtiv mecarbil compared with placebo was large and significant in patients with low SBP. Omecamtiv mecarbil did not affect SBP and was well tolerated independent of SBP values.
摘要：
目的：射血分数降低和收缩压（SBP）低的心力衰竭患者死亡率高，住院治疗,对循证医学治疗的耐受性较差。Omecamtivmecarbil可能对此类患者特别有帮助。这项研究检查了SBP≤100mmHg的患者的疗效和耐受性，该患者参加了通过改善心力衰竭收缩力来降低不良心脏结局的全球方法（GALACTIC-HF）。
结果：GALACTIC-HF纳入基线SBP≥85mmHg的患者，主要结局为心血管死亡或首次心力衰竭事件发生时间。在这个分析中,根据基线SBP（≤100vs.>100mmHg）。在8232名接受分析的患者中，1473（17.9％）的基线SBP≤100mmHg，6759（82.1％）的SBP>100mmHg。主要结局发生在SBP≤100和>100mmHg的715例（48.5％）和2415例（35.7％）患者中，分别。SBP较低的患者发生不良后果的风险较高。Omecamtivmecarbil,与安慰剂相比，在SBP≤100mmHg[风险比（HR），0.81；95%置信区间(CI)，0.70-0.94]与SBP>100mmHg(HR，0.95；95%CI，0.88-1.03；交互作用的P值=0.051）。在这两组中,omecamtivmecarbil没有随时间改变SBP值，也没有增加不良事件的风险，与安慰剂相比。
结论：在GALACTIC-HF中，在低SBP患者中,与安慰剂相比,omecamtivmecarbil降低心力衰竭结局的风险较大且显著.Omecamtivmecarbil不影响SBP，并且耐受性良好，与SBP值无关。
结果：GALACTIC-HF纳入基线SBP≥85mmHg的患者，主要结局为心血管死亡或首次心力衰竭事件发生时间。在这个分析中,根据基线SBP（≤100vs.>100mmHg）。在8232名接受分析的患者中，1473（17.9％）的基线SBP≤100mmHg，6759（82.1％）的SBP>100mmHg。主要结局发生在SBP≤100和>100mmHg的715例（48.5％）和2415例（35.7％）患者中，分别。SBP较低的患者发生不良后果的风险较高。Omecamtivmecarbil,与安慰剂相比，在SBP≤100mmHg[风险比（HR），0.81；95%置信区间(CI)，0.70-0.94]与SBP>100mmHg(HR，0.95；95%CI，0.88-1.03；交互作用的P值=0.051）。在这两组中,omecamtivmecarbil没有随时间改变SBP值，也没有增加不良事件的风险，与安慰剂相比。
结论：在GALACTIC-HF中，在低SBP患者中,与安慰剂相比,omecamtivmecarbil降低心力衰竭结局的风险较大且显著.Omecamtivmecarbil不影响SBP，并且耐受性良好，与SBP值无关。
