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Development of hypotension in patients newly diagnosed with heart failure in UK general practice: retrospective cohort and nested case–control analyses
  1. Mar Martín-Pérez1,
  2. Alexander Michel2,
  3. Mark Ma3,
  4. Luis Alberto García Rodríguez1
  1. 1 Centro Español de Investigación Farmacoepidemiológica (CEIFE), Madrid, Spain
  2. 2 Epidemiology, Bayer Basel, Basel, Switzerland
  3. 3 Bayer US LLC, Whippany, New Jersey, USA
  1. Correspondence to Dr Luis Alberto García Rodríguez; lagarcia{at}


Objectives Hypotension is of particular relevance for patients with heart failure (HF), since almost all HF drugs cause lowering of blood pressure (BP) and it is associated with a poor prognosis. We aimed to investigate hypotension incidence and risk factors in patients with incident HF in the UK.

Design Retrospective cohort study including nested case–control analyses.

Setting The Health Improvement Network UK primary care database.

Participants 18 677 adult patients with incident HF during 2000–2005 were followed and cases of hypotension (systolic BP ≤90 mm Hg) were identified. Controls were age-matched, sex-matched and date-matched to cases (1:2).

Primary and secondary outcome measures We estimated hypotension incidence in the full study population and relevant subgroups (eg, sex and age). Potential risk factors for hypotension overall and for multiple versus single hypotensive episodes were evaluated using conditional logistic regression and unconditional regression models, respectively.

Results During a mean follow-up of 3.31 years, 2565 patients (13.7%) developed hypotension. The incidence of hypotension was 3.17 cases per 100 patient years (95% confidence interval (CI): 3.05–3.30), and was markedly increased in women aged 18–39 years (n=32; 17.72 cases per 100 patient-years; 95% CI: 9.69–29.73). Hypotension risk factors included high healthcare utilisation (proxy measure for HF severity and general comorbidity; eg, ≥10 primary care physician visits versus none, odds ratio (OR): 2.29; 95% CI: 1.34–3.90), previous hypotensive episodes (OR: 2.32; 95% CI: 1.84–2.92), renal failure and use of aldosterone antagonists, angiotensin-converting enzyme inhibitors and angiotensin receptor blockers. Risk factors identified for hypotension generally overlapped with those for multiple versus single hypotensive episodes.

Conclusions Hypotension occurs frequently in patients with incident HF. Our findings may help identify patients most likely to benefit from close BP monitoring. The increased incidence of hypotension in young women with HF requires investigation.

  • primary care
  • heart failure
  • hypotension
  • blood pressure
  • incidence
  • risk factors

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  • Contributors Conception and design of the research: all authors. Acquisition of data: MM-P, LAGR. Analysis and interpretation of data: MM-P, AM, LAGR. Statistical analysis: MM-P. Obtaining funding and supervising the work: AM, LAGR. Drafting the manuscript: MM, MM-P, AM. Critical revision of the manuscript: all authors. All authors have read and approved the final manuscript.

  • Funding This work was supported by Bayer AG.

  • Competing interests MM-P and LAGR work for CEIFE, which has received a research grant from Bayer Pharma AG, Germany. LAGR has also served as an advisory board member for Bayer Pharma AG, Germany. AM is a salaried, full-time employee of Bayer Basel, Switzerland. MM is a salaried, full-time employee of Bayer US LLC., USA.

  • Ethics approval Data collection for THIN was approved by the South East Multicentre Research Ethics Committee (MREC) in 2003. The study protocol was approved by an independent Scientific Review Committee (reference number 16THIN086).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement This analysis is based on a large sample from The Health Improvement Network, provided by IMS Health. The authors’ licence for using these data precludes the sharing of raw data with third parties.

  • Patient consent for publication Not required. This study involved the use of anonymised patient medical records, which contained no information that could reasonably be used to identify people.

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