Orthostatic Pulse Pressure and SGLT2 Inhibitors: Findings from PRESERVED-HF | JACC Baran

Hosts Mitsuaki Sawano, MD, Shun Kohsaka, MD, Nobuhiro Ikemura, MD, and Satoshi Shoji, MD, welcome Dr. Hidenori Yaku to discuss orthostatic pulse pressure (OPP) as a marker of preload insufficiency in HFpEF, based on a prespecified analysis from the PRESERVED-HF trial. Dr. Yaku reviews findings from 324 patients with HFpEF randomized to dapagliflozin or placebo. Across groups with high, intermediate, or low OPP, dapagliflozin improved health status as measured by the Kansas City Cardiomyopathy Questionnaire and increased six-minute walk distance, with no significant interaction by OPP level. However, fluid depletion–related adverse events, although infrequent overall, were observed more often in patients with the lowest OPP. These results suggest that simple measurement of OPP may help identify patients at higher risk for volume depletion events, while the symptomatic and functional benefits of SGLT2 inhibition are preserved across the spectrum of OPP.