Influence of systolic blood pressure on clinical outcomes in elderly heart failure patients treated with nebivolol: data from the SENIORS trial

Aims There is limited information about the effects of beta‐blockers in heart failure ( HF ) stratified by blood pressure, especially in the elderly and those with preserved EF . We evaluate the effects of nebivolol on outcomes in elderly patients with HF stratified by baseline systolic blood pressure ( SBP ) and EF . Methods and results The SENIORS trial evaluated the effects of nebivolol and enrolled 2128 patients ≥70 years of age with HF . Patients were divided into three baseline pre‐treatment SBP categories (<110, 110–130, and >130  mmHg ). In addition, we evaluated the influence of SBP (≤130 and >130  mmHg ) on patients with LVEF <40% vs. ≥40%. Low baseline SBP was associated with worse clinical outcomes irrespective of treatment group, both in patients with reduced EF and in those with preserved EF . Nebivolol had similar benefits irrespective of baseline SBP : the hazard ratio ( HR ) for primary outcome of all‐cause mortality or cardiovascular hospitalization in the three SBP categories for nebivolol vs. placebo was 0.85 [95% confidence interval ( CI ) 0.50–1.45], 0.79 (95% CI 0.61–1.01), and 0.88 (95% CI 0.72–1.07), respectively ( P for interaction = 0.61). Similar results were obtained for the secondary endpoint of all‐cause mortality. There was no significant interaction for the effects of nebivolol by baseline SBP stratified by LVEF . Conclusions Elderly HF patients with lower SBP have a worse outcome than those with higher SBP , but nebivolol appears to be safe and well tolerated, with similar benefits on the composite outcome of death or cardiovascular hospital admission irrespective of baseline SBP and LVEF .