Visit-to-visit blood pressure variability in patients with chronic heart failure with reduced ejection fraction

Background: There is a growing evidence of the prognostic significance of visit-to-visit blood pressure variation in different groups of patients but for heart failure with reduced ejection fractions remains a matter of controversy. Objective: The objective of the study was to evaluate the impact of visit-to-visit blood pressure variability (BPV) on the prognosis in patients with stable heart failure (HF) with reduced ejection fraction (EF). Methods: The retrospective analysis included 100 pts (80 men, age 64.4 ± 9.3 years, baseline BP 127.6 ± 15.1/77.9 ± 8.3 mmHg) with chronic heart failure II-IV NYHA functional class with mean EF 32.3 ± 4.3%. All patients received optimal medical therapy for HF. BP was measured with a validated oscillometric device. Visit-to-visit BPV was calculated as standard deviation, and the coefficient of variation of average BP for seven visits during 18 months. The endpoints were death, myocardial infarction, stroke, and hospitalization for HF. Results: Visit-to-visit systolic BPV (SBPV) ranged between 2.3 and 20.0 mmHg. A total of 47 endpoints in 37 patients were recorded. The patients with endpoints had higher visit-to-visit SBPV (11.2 ± 4.0 vs. 9.5 ± 3.5 mmHg, P < 0.05). Logistic regression analysis revealed that the risk of all negative outcomes was independently associated with lower EF (adjusted odds ratio (aOR) 0.84; 95% confidence interval (CI): 0.73-0.97; P = 0.02) and SBPV > 10.9 mmHg (aOR 3.0; 95% CI: 1.27–7.06; P = 0.01). Conclusions: Visit-to-visit SBPV >10.9 mmHg as well as lower EF were independently associated with negative outcomes in patients with stable HF with reduced EF.