In-Hospital Nighttime Blood Pressure and Heart Failure Hospitalization After Discharge in Chronic Coronary Disease

Nighttime blood pressure provides prognostic information beyond conventional measurements, but routine nocturnal assessment remains uncommon. We investigated whether automated nighttime blood pressure is associated with subsequent heart failure hospitalization in chronic coronary disease.

We conducted a single-center retrospective study of hospitalized patients with chronic coronary disease who underwent automated nighttime blood pressure monitoring between July 2013 and October 2017. After excluding 66 patients with insufficient measurements, 485 were analyzed. Blood pressure was recorded hourly from 23:00 to 06:00. The primary endpoint was first heart failure hospitalization after discharge, with all-cause death as a competing event; the secondary endpoint was all-cause mortality.

Median age was 69 years, and 360 patients were men. Nocturnal hypertension was present in 301 patients. During a median follow-up of 4.2 years, 50 patients experienced heart failure hospitalization and 31 died. At 4 years, the cumulative incidence of heart failure hospitalization was 7.4% versus 2.2% in patients with versus without nocturnal hypertension, and that of all-cause death was 7.7% versus 4.0%. Per 10-mmHg higher mean nocturnal systolic blood pressure, the subdistribution hazard ratio for heart failure hospitalization was 1.24 (95% confidence interval, 1.08-1.42), or 1.19 (1.04-1.37) after adjustment for office systolic blood pressure; the corresponding subdistribution hazard ratio for office systolic blood pressure was 1.24 (0.99-1.55).

Higher pre-discharge mean nocturnal systolic blood pressure was associated with subsequent heart failure hospitalization in chronic coronary disease. Automated in-hospital nighttime blood pressure monitoring may help identify patients at increased post-discharge heart failure risk.