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

Manuel Montero-Perez-Barquero, Marcus Flather, Michael Roughton, Andrew Coats, Michael Böhm, Dirk J. Van Veldhuisen, Daphne Babalis, Alain Cohen Solal, Luis Manzano

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21 Citations (Scopus)


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.
Original languageEnglish
Pages (from-to)1009-1015
Number of pages7
JournalEuropean Journal of Heart Failure
Issue number9
Early online date16 Jul 2014
Publication statusPublished - Sep 2014


  • Heart failure
  • Blood pressure
  • Elderly
  • Prognosis
  • Beta-blockers

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