Acute decompensated heart failure (ADHF) is characterized by marked clinical and hemodynamic heterogeneity, making the interpretation of blood pressure (BP) particularly challenging[1]. Low BP is frequently perceived as a marker of poor prognosis and, in daily practice, often triggers therapeutic caution, particularly regarding guideline-directed medical therapy (GDMT)[1,2]. However, BP alone provides an incomplete representation of the hemodynamic status of patients with ADHF. The distinction between hypotension and hypoperfusion is therefore crucial, as patients with low BP but preserved organ perfusion represent a fundamentally different phenotype from those with cardiogenic shock[3].
