Vericiguat Significantly Reduces `NT-proBNP` in **HFrEF** Patients with Asymptomatic Hypotension

Heart Failure with Reduced Ejection Fraction (HFrEF) remains a major cause of morbidity and mortality, despite advances in guideline-directed medical therapy (GDMT). A significant challenge in managing these patients is the presence of asymptomatic hypotension (systolic blood pressure ≤ 100 mmHg), which often limits the titration of crucial GDMT agents. This leaves a vulnerable subpopulation undertreated. Vericiguat, a soluble guanylate cyclase (sGC) stimulator, enhances the cGMP pathway, promoting vasodilation and myocardial relaxation, offering a potential therapeutic avenue for these patients where other therapies might be contraindicated or poorly tolerated due to blood pressure concerns.

This multicenter observational cohort study enrolled 164 patients diagnosed with HFrEF and concomitant asymptomatic hypotension (systolic blood pressure ≤ 100 mmHg). Patients voluntarily decided whether to receive vericiguat treatment. To account for non-random allocation, propensity score matching (1:2) was applied. The primary endpoint was the first occurrence of a ≥30% reduction in N-terminal pro-B-type natriuretic peptide (NT-proBNP) from baseline at any assessment during follow-up. Kaplan-Meier (K-M) analysis and multivariable Cox regression models were used to evaluate outcomes.

A total of 61 vericiguat-treated patients and 36 controls completed the study after propensity score matching. > The incidence of a significant NT-proBNP reduction (≥30%) was 68.8% in the vericiguat group, which was significantly higher than the 47.2% observed in the control group. Kaplan-Meier analysis further demonstrated a significantly higher cumulative incidence of NT-proBNP reduction in the vericiguat group compared to controls (hazard ratio (HR) = 2.54, 95% confidence interval (CI): 1.42-4.55, P < 0.001). Multivariate Cox regression confirmed that vericiguat treatment was an independent predictor of significant NT-proBNP reduction (Model 3: HR = 2.34, 95% CI: 1.30-4.21, P = 0.004). The study also noted a small number of adverse events and no major safety concerns.