Why the study?
The association between the prognosis of heart failure across different ejection fraction categories and abnormal blood pressure variations on ambulatory blood pressure monitoring remained unclear.
Does a blood pressure riser pattern predict mortality in patients with acute heart failure across different ejection fraction categories?
Does a blood pressure riser pattern predict mortality in patients with acute heart failure across different ejection fraction categories?
A riser pattern of systolic blood pressure on ambulatory monitoring is an independent predictor of adverse outcomes specifically in patients with HFpEF.
Riser pattern may flag higher risk in HFpEF; leaves open whether ABPM-guided BP control alters outcomes.
AIMS: Heart failure (HF) is classified into three types according to left ventricular ejection fraction (EF). The effect of blood pressure (BP) on the pathogenesis of each type is assumed to be different. However, the association between the prognosis of each type of HF and abnormal BP variations assessed by ambulatory BP monitoring (ABPM), such as nocturnal hypertension and the riser pattern, remains unclear. METHODS AND RESULTS: We studied 325 consecutive patients with decompensated HF who were acutely admitted to our hospital and underwent ABPM at discharge. During a mean follow-up of 30.0 months, 52 cardiovascular and 112 all-cause deaths occurred. The Cox proportional hazards model showed that the mean values of 24 h, awake, and sleep-time systolic BP (SBP), and abnormal 24 h ABPM patterns, such as nocturnal hypertension and non-dipper pattern, were not associated with either all-cause or cardiovascular mortality in patients with HF with reduced EF (HFrEF), HF with mid-range EF (HFmrEF), or HF with preserved EF (HFpEF), except for sleep-time SBP in HFrEF. However, the riser pattern was a significant and independent predictor of all-cause and cardiovascular deaths in patients with HFpEF (hazard ratio, 2.01; 95% confidence interval, 1.12-3.62; 0.0200; and hazard ratio, 2.48; 95% confidence interval, 1.08-5.90; 0.0332, respectively). Sleep-time pulse rate was similarly decreased in both the riser and non-riser groups. CONCLUSIONS: The riser pattern of SBP was associated with an increased risk of adverse outcomes among patients with HFpEF but not HFrEF or HFmrEF.
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Ueda et al. (2019) studied this question.
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