Key result
Higher 24-hour SBP in advanced HFrEF is linked to ~15% greater one-year survival per mmHg.
Why the study?
Does lower ambulatory blood pressure and a dipping pattern predict reduced one-year survival in patients with advanced HFrEF?
Cohort (n=100)
No
Does lower ambulatory blood pressure and a dipping pattern predict reduced one-year survival in patients with advanced HFrEF?
In patients with advanced HFrEF on optimal medical therapy, lower 24-hour ambulatory blood pressure and a dipping pattern are associated with significantly reduced one-year survival.
Answers are grounded in this paper and cite their sources.
Lower ambulatory BP may identify higher mortality risk in advanced HFrEF; hypothesis-generating and should not yet change practice.
BACKGROUND: Ambulatory blood pressure monitoring (ABPM) in heart failure is not well defined. However, from the limited studies available, ABPM may be used to optimize heart failure therapy, and as a prognostic marker in this patient group. We analyzed the ABPM values with survival in advanced heart failure with reduced ejection fraction (HFrEF) patients who are on optimal guideline directed medical therapy (GDMT). METHODS AND RESULTS: Hundred patients of advanced HFrEF were followed up for one year. Baseline left ventricular ejection fraction (LVEF), left ventricular end diastolic diamension (LVEDD) and ABPM values were measured and they were analyzed with survival. Deceased patients (n=36) have lower ABPM values and are dippers as compared to living patients (n=64) [24hr systolic blood pressure (SBP24hr)=97.6±12.5mmHg, 24hr diastolic BP (DBP24hr)=64.6±10.2mmHg, decrement in systolic BP (dipSBP)=9.9±5.2mmHg and decrement in diastolic BP (dipDBP)=11.1±6.5mmHg Vs SBP24hr=109.4±16.9mmHg, DBP24hr=71.7±17mmHg, dipSBP=1.6±5.9mmHg and dipDBP=2.7±6.3mmHg] and they were statistically significant with p values<0.001, 0.025, <0.001, and <0.001 respectively. A logistic regression analysis was done to predict one year survival using age, sex, LVEF, LVEDD, SBP24hrs, DBP24hrs, dipSBP, dipDBP and dipMAP as independent predictors. When SBP24hrs is raised by one unit the chances of survival are 1.145 times more(Exp(B)=1.145). One unit dip in SBP and DBP will reduce the chances of survival by 0.697 times and 0.586 times respectively. CONCLUSION: In advanced HFrEF patients with Lower SBP & DBP and dippers have lesser survival compared to those with higher SBP & DBP and non-dippers.
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Kotti et al. (2017) conducted a cohort in Advanced heart failure with reduced ejection fraction (HFrEF) (n=100). Ambulatory blood pressure monitoring (ABPM) was evaluated on One-year survival predicted by 24-hour systolic blood pressure (OR 1.145, 95% CI 1.035-1.266, p=0.008). In patients with advanced heart failure with reduced ejection fraction, a 1 mmHg increase in 24-hour systolic blood pressure was associated with higher one-year survival.
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