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[The prognostic value of transient arterial hypertension in patients with chronic heart insufficiency and preserved
Insights
Transient arterial hypotension is common in chronic heart insufficiency patients with preserved ejection function, significantly increasing risks for heart attack and cardiovascular death. Monitoring arterial pressure (AP) is crucial for identifying these dangerous episodes.
Area of Science:
- Cardiology
- Internal Medicine
Background:
- Chronic heart insufficiency (CHI) exhibits a J-shaped mortality curve related to arterial pressure (AP), indicating risks from both high and low AP.
- Preserved left ventricular ejection function (CHI-PEF) is a specific subtype of CHI.
- Understanding AP fluctuations is vital for managing CHI patients.
Purpose of the Study:
- To determine the frequency of arterial hypotension episodes in CHI-PEF patients.
- To evaluate the prognostic significance of arterial hypotension in CHI-PEF patients.
Main Methods:
- A cohort of 169 patients with CHI-PEF (mean age 56.3±10.9 years) was studied over 24 months.
- Patients were classified by CHI functional class (FCII/FCIII) and disease stage (IIA/IIB).
- Outcomes included non-fatal myocardial infarction and cardiovascular death, with 24-hour AP monitoring used to detect transient hypotension.
Main Results:
- Arterial hypotension was diagnosed in 9.5% of patients via office AP measurements.
- 24-hour AP monitoring revealed transient arterial hypotension in 61.6% of patients.
- All 8 documented combined endpoints (myocardial infarction, cardiovascular death) occurred in patients with transient systolic-diastolic and/or systolic hypotension. No events occurred in patients without hypotension (x=4.28, p=0.04).
Conclusions:
- 24-hour AP monitoring effectively detects potentially dangerous AP changes in CHI-PEF patients.
- Transient arterial hypotension affects a significant majority (61.6%) of FCII-III CHI-PEF patients.
- Transient hypotension substantially elevates the risk of non-fatal myocardial infarction and cardiovascular death in this population.
Abstract:
There is a J-like dependence of mortality among patients with chronic heart insufficiency (CHI) on arterial pressure (AP). This implies the possibility of not only elevation but also fall of AP in such patients. The aim of the study was to determine the frequency and prognostic value of arterial hypotension episodes in CHI patients with preserved left ventricular ejection function (CHI-PEF). .
Materials And Methods:
The study included 169patients (74 men and 95 women) with CHI (mean age 56,3±10,9 yr). All of them had PEF higher than 50%. 105 patients had FCII CHI, 64 ones FCIII CHI. Stage IIA was documented in 136 and stage IIB in 33 patients. Duration of the study 24 months. The combined end point included non-fatal myocardial infarction and cardiovascular death.
Results:
Arterial hypotension at office AP was diagnosed in 16 (9,5%) patients, transient arterial hypotension based at 24 hr AP monitoring in 104 (61,6%) patients. A total of 8 combined end points were documented during the study period. All these patients had transient systole-diastolic and/or systolic arterial hypotension . No myocardial infarction or lethal outcome developed in CHI patients without episodes of arterial hypotension (x=4,28, р=0,04).
Conclusion:
24 hr AP monitoring in CHI-PEF patients permits to significantly increase the frequency of detection ofpotentially dangerous changes of AP. Transient arterial pressure occurs in 61.6% of the FCII-III CHI-PEF patients. Transient systole-diastolic arterial hypotension significantly increases the risk of non-fatal myocardial infarction and cardiovascular death in CHI-PEF patients
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