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Is ambulatory blood pressure measurement a new indicator for survival among advanced heart failure cases
Kotti K1, Rajeev Bagarhatta1, Monicka Rathore2
1Department of Cardiology, SMS Medical College and hospital, Jaipur, Rajasthan 302015, India.
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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Monitoring Both Arms:
Monitoring BP in both arms during the initial assessment is advisable, as the systolic value may differ by five to ten mm Hg between arms. For subsequent BP assessments, use the arm with the higher reading.