BACKGROUND: Early clinical data showed that some patients with vasodilatory shock are responsive to low doses of angiotensin II. The objective of this analysis was to compare clinical outcomes in patients requiring /= 75 mmHg versus patients receiving > 5 ng kg(-1) min(-1) angiotensin II at 30 min (> 5 ng kg(-1) min(-1) subgroup). Data from angiotensin II-treated patients enrolled in the ATHOS-3 trial were used. RESULTS: The subgroup of patients whose angiotensin II dose was down-titrated from 20 ng kg(-1) min(-1) at treatment initiation to 5 ng kg(-1) min(-1) subgroup (84/163). Patients in the 5 ng kg(-1) min(-1) subgroup (90% vs. 51%, respectively; odds ratio, 8.46 [95% CI 3.63-19.7], P < 0.001). Day 28 survival was also higher in the 5 ng kg(-1) min(-1) subgroup (59% vs. 33%, respectively; hazard ratio, 0.48 [95% CI 0.28-0.72], P = 0.0007); multivariate analyses supported the survival benefit in patients with lower angiotensin II levels. The 5 ng kg(-1) min(-1) subgroup. CONCLUSIONS: This prespecified analysis showed that down-titration to