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Diurnal blood pressure profile in patients with severe congestive heart failure: dippers and non-dippers
J Kastrup1, H Wroblewski, J Sindrup
1Department of Medicine B, University Hospital, Righospitalet, Copenhagen, Denmark.
Insights
Severe congestive heart failure (CHF) patients show altered diurnal blood pressure rhythms. More CHF patients are non-dippers, lacking a normal nocturnal blood pressure decrease, compared to healthy controls.
Area of Science:
- Cardiology
- Hypertension Research
- Physiology
Background:
- Severe congestive heart failure (CHF) is associated with heightened sympathetic nervous activity and impaired baroreceptor function.
- These physiological changes in CHF patients may impact the normal diurnal variation in blood pressure.
Purpose of the Study:
- To investigate the 24-hour blood pressure profiles in patients with severe congestive heart failure.
- To compare the diurnal blood pressure patterns, specifically nocturnal dipping, between severe CHF patients and control subjects.
Main Methods:
- Systemic blood pressure was monitored non-invasively every 15 minutes over 24 hours in 25 severe CHF patients and 25 controls.
- Subjects were categorized into 'dippers' (normal nocturnal systolic blood pressure decrease >10%) and 'non-dippers'.
Main Results:
- Severe CHF patients exhibited significantly lower systolic blood pressure during both day and night compared to controls.
- The nocturnal decrease in systolic blood pressure was significantly reduced in CHF patients (9%) versus controls (18%).
- A higher proportion of CHF patients were classified as non-dippers (16/25) compared to controls (5/25).
Conclusions:
- Patients with severe congestive heart failure demonstrate an abnormal diurnal blood pressure rhythm.
- The classification of dippers and non-dippers is relevant in severe CHF, with a significant prevalence of non-dippers indicating impaired nocturnal blood pressure regulation.
Abstract:
Patients with severe congestive heart failure (CHF) have increased sympathetic nervous activity and altered baroreceptor function, which may influence the diurnal blood pressure rhythm. The 24-h blood pressure profile was measured in 25 patients with severe CHF (mean ejection fraction: 17%) and 25 control subjects. Systemic blood pressure was measured automatically at the arm by a non-invasive blood pressure monitoring system every 15 min. The mean +/- SD systolic blood pressure in CHF patients and controls was during day-time 105 +/- 10 and 130 +/- 11 mm Hg and night-time 97 +/- 10 and 112 +/- 10 mm Hg, i.e. the nocturnal decrease was 9 +/- 6 and 18 +/- 8 mm Hg, respectively (p < 0.0005 for all). The subjects could be divided into two groups: dippers and non-dippers, with and without a relative decrease in nocturnal systolic blood pressure > 10%. There was significantly more non-dipping CHF patients (16) than controls (5) (p < 0.01). Systolic blood pressure was in CHF dippers vs. non-dippers during day-time: 108 +/- 7 vs. 104 +/- 12 mm Hg (NS) and night-time: 92 +/- 7 vs. 99 +/- 11 mm Hg (p = 0.08). The nocturnal decrease was 16 +/- 3 vs. 5 +/- 4 mm Hg and the relative nocturnal decrease 15 +/- 3 vs. 5 +/- 3% (p < 0.00001 for both). It is concluded that patients with severe congestive heart failure can be divided into two groups: dippers and non-dippers, with and without a normal decrease in nocturnal blood pressure.(ABSTRACT TRUNCATED AT 250 WORDS)