UPDATED GUIDELINE-BASED MANAGEMENT OF HEART FAILURE WITH REDUCED EJECTION FRACTION IN ELDERLY PATIENTS WITH LOW BLOOD PRESSURE
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Abstract
Heart failure with reduced ejection fraction (HFrEF) represents a major global health burden, characterized by high rates of morbidity, hospitalization, and mortality, particularly among elderly patients. Low blood pressure is a common condition in this population, associated with worse prognosis and challenges in optimizing guideline-directed medical therapy (GDMT). Evidence from randomized controlled trials and real-world studies demonstrates that the benefits of GDMT persist even in patients with low blood pressure. Among the foundational therapies, sodium–glucose cotransporter-2 inhibitors (SGLT2i) and mineralocorticoid receptor antagonists (MRA) have minimal hemodynamic effects and can be initiated early, whereas angiotensin receptor–neprilysin inhibitors (ARNi), angiotensin-converting enzyme inhibitors (ACEi), and beta-blockers (BB) should be started at low doses and carefully up-titrated. In Vietnam, prescription rates of GDMT remain limited; however, current evidence highlights the importance of maintaining GDMT to the maximum tolerated extent, alongside evaluating secondary causes of hypotension and tailoring therapy to individual patients. This review summarizes updated evidence, discusses pharmacodynamic considerations, and proposes clinical strategies for managing elderly patients with HFrEF and low blood pressure, emphasizing the role of comprehensive geriatric assessment in achieving safe and effective therapy
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- Kounis NG. Coronary Hypersensitivity Disorder: The Kounis Syndrome. Clinical Therapeutics. 2013 2013/05/01/;35(5):563-571. doi: https://doi.org/10.1016/j.clinthera.2013.02.022. DOI: https://doi.org/10.1016/j.clinthera.2013.02.022
- Alblaihed L, Huis In 't Veld MA. Allergic Acute Coronary Syndrome-Kounis Syndrome. Emerg Med Clin North Am. 2022 2022/02//;40(1):69-78. doi: 10.1016/j.emc.2021.08.010. Abdelghany M, Subedi R, Shah S, et al. Kounis syndrome: A review article on epidemiology, diagnostic findings, management and complications of allergic acute coronary syndrome. International Journal of Cardiology. 2017 2017/04/01/;232:1-4. doi: https://doi.org/10.1016/j.ijcard.2017.01.124. DOI: https://doi.org/10.1016/j.ijcard.2017.01.124
- Hanna EB, Glancy DL. ST-segment elevation: Differential diagnosis, caveats. Cleveland Clinic Journal of Medicine. 2015 2015/06;82(6):373-384. doi: 10.3949/ccjm.82a.14026. DOI: https://doi.org/10.3949/ccjm.82a.14026
- Forzese E, Pitrone C, Cianci V, et al. An Insight into Kounis Syndrome: Bridging Clinical Knowledge with Forensic Perspectives. 2024;14(1):91. PubMed PMID: doi:10.3390/life14010091. DOI: https://doi.org/10.3390/life14010091
- Renda F, Marotta E, Landoni G, et al. Kounis syndrome due to antibiotics: A global overview from pharmacovigilance databases. International Journal of Cardiology. 2016 2016/12/01/;224:406-411. doi: https://doi.org/10.1016/j.ijcard.2016.09.066. DOI: https://doi.org/10.1016/j.ijcard.2016.09.066
- Buttner R, Cadogan M. Kounis Syndrome: LITFL; 2021 [updated 2021/04/21]. Available from: https://litfl.com/kounis-syndrome/
- Omri M, Kraiem H, Mejri O, et al. Management of Kounis syndrome: two case reports. Journal of Medical Case Reports. 2017 2017/05/23;11(1):145. doi: 10.1186/s13256-017-1310-7. DOI: https://doi.org/10.1186/s13256-017-1310-7
- Kounis NG, Koniari I, Velissaris D, et al. Kounis Syndrome—not a Single-organ Arterial Disorder but a Multisystem and Multidisciplinary Disease. Balkan medical journal. 2019 Jul 11;36(4):212-221. doi: 10.4274/balkanmedj.galenos.2019.2019.5.62. PubMed PMID: 31198019; PubMed Central PMCID: PMCPMC6636655. eng. DOI: https://doi.org/10.4274/balkanmedj.galenos.2019.2019.5.62
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