The Impact of Glucocorticoid Therapy on Guideline-Directed Medical Treatment Titration in Patients Hospitalized for Heart Failure with Low Blood Pressure: A Retrospective Study

Shuyu Li,1,2 Qingzhen Zhao,1 Yuzhi Zhen,1 Lizhuo Li,1 Yiqing Mi,1 Tongxin Li,1 Kunshen Liu,1 Chao Liu1 1The First Cardiology Division, First Affiliated Hospital of Hebei Medical University, Shijiazhuang, 050022, People’s Republic of China; 2The Second Cardiology Division, North China University of Science and Technology Affiliated Hospital, Tangshan, 063000, People’s Republic of ChinaCorrespondence: Chao LiuThe First Cardiology Division, First Affiliated Hospital of Hebei Medical University, Hebei Medical University, No. 89 of Donggang Road, Yuhua District, Shijiazhuang, Hebei, 050000, People’s Republic of ChinaTel +86 311 8591 7032Fax +86 311 8591 7290Email dr.liuchao@gmail.comBackground: Positive inotropic and renal protective actions of glucocorticoids have been observed clinically. Therefore, glucocorticoids may be used in patients with heart failure and low blood pressure (HF-LBP).Methods: The medical records of 144 consecutive patients with HF-LBP who received glucocorticoids as an adjunctive treatment to facilitate the up-titration of β-blocker and angiotensin-converting enzyme inhibitor were reviewed.Results: After four weeks of treatment, the metoprolol and captopril (or equivalent) dosages were progressively and consistently increased from 25 (interquartile range [IQR] = 12.5– 75 mg/day) to 100 mg/day (IQR = 50– 178.8 mg/day) and from 0 (IQR = 0– 25 mg/day) to 12.5 mg/day (IQR = 0– 50 mg/day), respectively. There was a remarkable beneficial hemodynamic response to the glucocorticoid treatment signified by an increase in blood pressure and decrease in heart rate. The average heart rate decreased by 6 beat per minute (bpm) (0.5– 16 bpm), and the mean arterial blood pressure increased from 74.06 ± 7.81 to 78.85 ± 7.91 mmHg. We also observed an improvement in renal function and an increased diuretic response following glucocorticoid treatment. As a result, the left ventricular ejection fraction increased from 28.92 ± 8.06% to 33.86 ± 8.76%, and the diuretic response increased from 776.7 mL/40 mg furosemide (IQR = 133.8– 2000 mL) to 4000 mL/40 mg furosemide on day 28 (IQR = 2200– 5925 mL).Conclusion: The use of glucocorticoid treatment to maintain hemodynamic and renal functional targets when titrating guideline-directed medical treatment in patients with HF-LBP may be safe, effective, and feasible.Keywords: cardiac output, β-blocker, angiotensin-converting enzyme inhibitor, diuretic response, left ventricular ejection, renal function