Key result
Extreme and reverse nocturnal blood pressure dipping patterns on discharge ambulatory monitoring were associated with a 9.28-fold and 7.53-fold increased hazard of 3-month mortality, respectively, in patients with acute decompensated heart failure.
Why the study?
Ambulatory blood pressure monitoring offers dynamic evaluation of blood pressure patterns, variability, and morning blood pressure surge, which may provide prognostic value in acute decompensated heart failure.
Observational (n=300)
No
Hazard Ratio: 9.28 (95% CI 1.85–46.49)
Absolute Event Rate: 33.33% vs 0%
p-value: p=0.007
Discharge ambulatory blood pressure monitoring identifies abnormal circadian patterns, such as extreme and reverse dipping, which are strong independent predictors of short-term mortality in patients recently stabilized from acute decompensated heart failure.
Background and Objectives: Heart failure (HF) remains a major cause of morbidity and frequent readmissions in India. Ambulatory blood pressure monitoring (ABPM) offers dynamic evaluation of blood pressure (BP) patterns, BP variability and morning blood pressure surge (MBPS) which may provide prognostic value in patients with acute decompensated heart failure (ADHF). Methods: A prospective observational study enrolling 300 patients admitted with ADHF. After stabilization and prior to discharge, all patients underwent ABPM and were categorized based on dipper patterns. Clinical outcomes, including mortality and re-hospitalization at 3 months, were assessed. Survival analyses were performed using Kaplan-Meier curves and multivariable Cox regression. Results: The mean age of the cohort was 60.2 years; 68% were male. Most patients had HF with reduced ejection fraction (84%), and 57% were hypertensive. Dipper patterns were distributed: normal dipper 51%, non-dipper 36%, reverse dipper 11%, and extreme dipper 2%. At 3 months, mortality was 5.3% and re-hospitalization in 44% of patients. Kaplan-Meier analysis revealed increased mortality in reverse dippers, highest average real variability percentile, and low/high MBPS groups (p<0.0001). Multivariable Cox regression identified extreme dipper (hazard ratio [HR], 9.28; 95% confidence interval [CI], 1.85-46.49; p=0.007), reverse dipper (HR, 7.53; 95% CI, 2.47-22.10; p=0.01), low systolic BP (HR, 3.70; 95% CI, 1.22-11.22; p=0.02) associated to mortality. Conclusions: ABPM is a practical tool for risk stratification in HF. Abnormal nocturnal BP dipper patterns and increased BP variability were associated with increased adverse short-term outcomes in ADHF. Discharge ABPM may aid early risk stratification, while other circadian BP abnormalities primarily reflect disease severity rather than independent risk.
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Boob et al. (2026) conducted an observational in Acute decompensated heart failure (n=300). Extreme dipper pattern on ambulatory blood pressure monitoring vs. Normal dipper pattern was evaluated on All-cause mortality at 3 months (HR 9.28, 95% CI 1.85-46.49, p=0.007). Extreme and reverse nocturnal blood pressure dipping patterns on discharge ambulatory monitoring were associated with a 9.28-fold and 7.53-fold increased hazard of 3-month mortality, respectively, in patients with acute decompensated heart failure.
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