Clinical Associations and on-Treatment Changes of Central Systolic Blood Pressure and Ar Terial Stiffness in Patients With Decompensated Heart Failure

Objective: Heart failure (HF) remains one of the major causes of cardiovascular mortality worldwide. The results of studies on arterial stiffness (AS) and central blood pressure (cBP) in HF are contradictory. The aim of this study was to evaluate clinical associations of cBP and parameters of AS and their on-treatment changes after 6 months of stable guideline-directed medical therapy (GDMT) in patients with acute decompensated HF (ADHF). Design and method: In 54 patients (61% males, 69.6±10 years, HTN 100%, median (med) EF 51% (IQR 38;55%), NTproBNP 623 (500;1842)pg/ml; HFrEF 37%, HFmrEF 13%, HFpEF 50%), apart from routine tests (including congestion assessment by bioimpedance vector analysis, lung ultrasound, liver density by FibroScan, and venous excess ultrasound) we assessed cBP and AS with applanation tonometry (SphygmoCor) within 3-4 days after admission and after 6 months. cSBP>/=individual reference values, carotid-femoral pulse wave velocity (cfPWV)>10 m/s and >individual reference values, AS gradient (cfPWV/carotid-radial PWV) >/=1 were considered abnormal. p<0.05 was considered significant. Results: At admission and after 6 months med brachial (b)BP was 117(106;130)/70 (68;80) mmHg 116 (108;130) mmHg, bPP 47 (37;56) mmHg and 47 (39;55) mmHg (p>0.05); cBP 109.5(96;120.5)/71.5 (68;80) mmHg and 106.5(95;113)/73 (65;79) mmHg (p=0.02 for cSBP), cPP 35 (25;43) mmHg and 32.5 (24;38) mmHg (p>0.05), cfPWV 9.9 (6.8;13) m/s and 11.4 (8.5,14.4), m/s (p=0.04), augmentation index (AI@HR75) 20% (13;33%) and 24.5% (18;29%), (p=0.05), PP amplification 129 (120;146) mmHg and 126 (121;136) mmHg, (p=0.02), AS gradient 1.2 (0.9;1.8) and 1 (0.8;1.4) (p>0.05), respectively. Elevated cSBP at admission was observed in 33%, at 6 months – in 38.1%, PWV>10 m/s-in 48.1% and 61.9% respectively, cfPWV>individual reference values–in 33.3% and 66.7% respectively, AS gradient>/=1–in 70.3% and 95.2% respectively. There were no differences in parameters of AS and cSBP and frequencies of their elevation across EF phenotypes and no differences between groups with normal and elevated AS by characteristics of congestion. Conclusions: Patients admitted with ADHF had high frequency of CBP elevation and abnormal AS gradient. The significant increase in cSBP, cfPWV and decrease in PP amplification on stable GDMT needs further evaluation.