ACC CardiaCast Debunking Reasons for Delayed HF Treatment: BP Too Low (No Such Thing!)
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Nov 13, 2025 In this discussion, Dr. Keith C. Ferdinand, a cardiologist and expert in hypertension at Tulane University, challenges common misconceptions about low blood pressure in heart failure treatment. He emphasizes that low BP should not delay crucial therapies. Dr. Ferdinand highlights evidence that treatment benefits outweigh concerns about low numbers, discusses symptom vs. numeric assessments, and shares practical tips for managing orthostatic hypotension. His key message is clear: treat the patient, not just the numbers!
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Low BP Isn’t A Treatment Barrier
- Low blood pressure alone should not block guideline-directed heart failure therapy because medications still reduce death and hospitalization.
- Optimizing evidence-based therapy often negates the increased risk linked with lower BP.
Don’t Stop Meds Based On A Number
- Do not stop heart-failure medicines solely for a systolic number like <100 or <90 without symptoms.
- Assess for symptomatic hypotension before altering guideline-directed medical therapy.
Keep Meds With Orthostatic Drops
- Maintain BP medicines in patients with orthostatic hypotension unless true symptomatic harm occurs.
- Controlling BP with antihypertensives can be more beneficial than stopping them in these cases.