Patients with heart failure with reduced ejection fraction and low systolic blood pressure (SBP) have high mortality, hospitalizations, and poorly tolerate evidence-based medical treatment. Omecamtiv mecarbil may be particularly helpful in such patients. This study examined its efficacy and tolerability in patients with SBP ≤100 mmHg enrolled in GALACTIC-HF.


GALACTIC-HF enrolled patients with baseline SBP ≥85 mmHg with a primary outcome of time to cardiovascular death or first heart failure event. In this analysis, patients were divided according to their baseline SBP (≤100 mmHg versus >100 mmHg).


Among the 8,232 analyzed patients, 1,473 (17.9%) had baseline SBP ≤100 mmHg and 6,759 (82.1%) had SBP >100 mmHg. The primary outcome occurred in 715 (48.5%) and 2,415 (35.7%) patients with SBP ≤100 mmHg and >100 mmHg, respectively. Patients with lower SBP were at higher risk of adverse outcomes. Omecamtiv mecarbil, compared with placebo, appeared to be more effective in reducing the primary composite endpoint in patients with SBP ≤100 mmHg (hazard ratio [HR], 0.81; 95% confidence interval [CI], 0.70-0.94) compared with those with SBP >100 mmHg (HR, 0.95; 95% CI, 0.88-1.03; p-value for interaction = 0.051). In both groups, omecamtiv mecarbil did not change SBP values over time and did not increase the risk of adverse events, as compared with placebo.


In GALACTIC-HF, risk reduction of heart failure outcomes with omecamtiv mecarbil compared with placebo was large and significant in patients with low SBP. Omecamtiv mecarbil did not affect SBP and was well tolerated independent of SBP values.