Patients hospitalized for acute decompensated heart failure (ADHF) with low blood pressure (BP) represent a clinically challenging yet frequently encountered subgroup in daily practice [1,2]. Subclinical hypotension denotes low or borderline admission BP without clinical/biochemical hypoperfusion and therefores without inotropes, vasopressors, or short-term mechanical circulatory support (MCS) at baseline. Despite the well-established prognostic benefits of guideline-directed medical therapy (GDMT) in HF, these patients are often underrepresented in clinical trials, leaving uncertainty about optimal management and a lack of specific recommendations in current guidelines [3].
