2013


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2013/№6

Factors influencing 5‑year survival in patients with mild and moderate CHF: Role of office BP and parameters of 24‑h BP profile in disease prognosis

Kapanadze L. G.1, Gerasimova V. V.1, Mareev Yu. V.1, Rogoza A. N.1, Mareev V. Yu. 2
1 - Federal State Budgetary Institution, “Russian Cardiology Research and Production Complex” of the RF Ministry of Health Care, 3rd Cherepkovskaya 15a, Moscow 121552
2 - Federal State Budgetary Educational Institution of Higher Professional Education “M. V. Lomonosov Moscow State University”, Leninskie Gory 1, GSP-1, Moscow 119991

Keywords: patient survival, prognosis, daily monitoring of arterial pressure, CHF

DOI: 10.18087/rhfj.2013.6.1915

Background. Since CHF has an unfavorable course and mortality of CHF patients is high, defining roles of various factors in CHF prognosis is very important. Aim. Studying the significance of office BP and parameters of 24h BP profile for risk stratification and determination of prognosis in CHF. Materials and methods. For evaluation of factors influencing the prognosis, case reports were retrospectively analyzed for 327 patients with SEHF FC II–III CHF evaluated between 1997 and 2006 at the Department of HF at the A. L. Myasnikov Institute of Clinical Cardiology. These patients were prospectively observed for 5 years after the 24h BP monitoring (BPM). Results. Low levels of office SBP (≤115 mm Hg) and pulse BP (PBP) (≤44 mm Hg) statistically significantly impaired 5year survival of patients with CHF whereas the presence of AH improved prognosis in these patients. A monofactorial analysis showed negative effects on prognosis of low night SBP values (<103 mm Hg), low variability of night SBP (<7.5 mm Hg), and absence of daytime SBP hypotensive episodes. A multifactorial analysis (Cox model) showed that the major factors determining the unfavorable 5year prognosis in CHF patients were FC III CHF, LV EF <35.3 %, absence of ACE inhibitor therapy, and two 24h BPM parameters, low night decrease of SBP (<7.5 mm Hg), and the absence of daytime hypotensive episodes probably due to no therapy with ACE inhibitors. Conclusion. For determining a high risk of all-cause death in CHF patients, in addition to well-recognized indices, 24BPM data on low BP variability and low values of nighttime SBP should be taken into consideration.
  1. Беленков Ю. Н., Мареев В. Ю. Агеев Ф. Т. Медикаментоз­ные пути улучшения прогноза больных хронической сердечной недостаточностью. – М.: Инсайт, 1997–80c.
  2. Беленков Ю. Н., Фомин И. В., Мареев В. Ю. и др. Первые результаты Российского эпидемиологического исследования по ХСН. Журнал Сердечная Недостаточность. 2003;4 (1):26–30.
  3. Беленков Ю. Н., Мареев В. Ю. Лечение сердечной недостаточности в XXI веке: достижения, вопросы и уроки доказательной медицины. Кардиология 2008;48 (2):6–16.
  4. Lee TT, Chen J, Cohen DJ, Tsao L. The association between blood pressure and mortality in patients with heart failure. Am Heart J. 2006;151 (1):76–83.
  5. Thohan V, Little WC. Is a higher blood pressure better in heart failure? Heart. 2009;95 (1):4–5.
  6. Anand IS, Rector TS, Kuskowski M et al. Effect of baseline and changes in systolic blood pressure over time on the effectiveness of valsartan in the Valsartan Heart Failure Trial. Circ Heart Fail. 2008;1 (1):34–42.
  7. Gheorghiade M, Abraham WT, Albert NM et al. Systolic blood pressure at admission, clinical characteristics, and outcomes in patients hospitalized with acute heart failure. JAMA. 2006;296 (18):2217–2226.
  8. Metra M, Torp-Pedersen C, Swedberg K et al. Influence of heart rate, blood pressure, and beta-blocker dose on outcome and the differences in outcome between carvedilol and metoprolol tartrate in patients with chronic heart failure: results from the COMET trial. Eur Heart J. 2005;26 (21):2259–2268.
  9. Rouleau JL, Roecker EB, Tendera M et al.Influence of pretreatment systolic blood pressure on the effect of carvedilol in patients with severe chronic heart failure: the Carvedilol Prospective Randomized Cumulative Survival (COPERNICUS) study. J Am Coll Cardiol. 2004;43 (8):1423–1429.
  10. Grigorian-Shamagian L, Gonzalez-JuAnatey JR, Vazquez R et al. Association of blood pressure and its evolving changes with the survival of patients with heart failure. J Card Fail. 2008;14 (7):561–568.
  11. Ghali JK, Kadakia S, Bhatt A et al. Survival of heart failure patients with preserved versus impaired systolic function: the prognostic implication of blood pressure. Am Heart J. 1992;123 (4 Pt 1):993–997.
  12. Canesin MF, Giorgi D, Oliveira MT Jr et al. Ambulatory blood pres­sure monitoring of patients with heart failure. A new prognosis marker. Arq Bras Cardiol. 2002;78 (1):83–89.
  13. Cohn JN, Archibald DG, Ziesche S et al. The Cardiac Insufficiency Bisoprolol Study II (CIBIS-II): a randomised trial. Lancet. 1999;353 (9146):9–13.
  14. MERIT-HF Study Group. Effect of metoprolol CR / XL in chro­nic heart failure: metoprolol CR / XL Randomized intervention trial in congestive heart failure (MERIT HF) Lancet. 1999;353 (9169):2001–2007.
  15. Solomon SD, Wang D, Finn P et al. Effect of candesartan on cause-specific mortality in heart failure patients. Circulation. 2004;110 (15):2180–2183.
  16. Cowie MR, Fox KF, Wood DA et al. Hospitalization of patients with heart failure: a population-based study. Eur Heart J. 2002;23 (11):877–885.
  17. Ho KKL, Pinsky JL, Kannel WB, Levy D. The epidemiology of heart failure: Framingham study. J Am Coll Cardiol. 1993;22 (4 Suppl A): 6A-13A.
  18. Герасимова В. В. Оценка функционального состояния и прогноз больных с выраженной сердечной недостаточностью (ретроспективное дясятилетнее наблюдение) Автореф. дис. канд. мед. наук. [место защиты ВКНЦ АМН СССР] – М.: 1991. – 19с.
  19. Wilson JR, Schwartz JS, Sutton MS et al. Prognosis in severe heart failure: Relation to hemodynamic measurements and ventricular ectopic activity. J Am Coll Cardiol. 1983;2 (3):403–410.
  20. Kelly TL, Cremo R, Nielsen C, Shabetai R. Prediction of outcome in latestage cardiomyopathy. Am Heart J. 1990;119 (5):1111–1121.
  21. Clugston GA, Smith ТЕ. Global nutrition problems and novel foods. Asia Pac J Clin Nutr. 2002;11 (Suppl 2):S100‑S111.
  22. Raphael CE, Whinnett ZI, Davies JE et al. Quantifying the paradoxi­cal effect of higher systolic blood pressure on mortality in chronic heart failure. Heart. 2009;95 (1):56–62.
  23. Senni M, Tribouilloy CM, Rodeheffer RJ et al: Congestive Heart Failure in the community: trends, incidence, and survival in a 10 year period. Arch Intern Med. 1999;159 (1):29–34.
  24. Mosterd A, Cost B, Hoes AW et al. The prognosis of heart failure in the general population: The Rotterdam Study. Eur Heart J. 2001;22 (15):1318–1327.
  25. Cowie MR, Wood DA, Coats AJ et al. Survival of patients with a new diagnosis of heart failure: a population-based study. Heart. 2000;83 (5):505–510.
  26. Rouleau JL, Roecker EB, Tendera M et al. Influence of pretreatment systolic blood pressure on the effect of carvedilol in patients with se­vere chronic heart failure: the Carvedilol Prospective Randomized Cu­mulative Survival (COPERNICUS) study. J Am Coll Cardiol. 2004;43 (8):1423–1429.
  27. Diaz RA, Obasohan A, Oakley CM. Prediction of outcome on dila­ted cardiomyopathy. Br Heart J. 1987;58 (4):393–399.
  28. Ather S, Chan W, Chillar A et al. Association of systolic blood pressure with mortality in patients with heart failure with reduced ejection fraction: a complex relationship. Am Heart J. 2011;161 (3):567–573.
  29. Jołda-Mydłowska B, Kobusiak-Prokopowicz M, Sławuta A, Witkowska M. [Pulse pressure as a prognostic indicator of organ damage in patients with essential hypertension]. Pol Arch Med Wewn. 2004;111 (5):527–535.
  30. Verdecchia P, Schillaci G, Borgioni C et al. Ambulatory Pulse Pressure A Potent Predictor of Total Cardiovascular Risk in Hypertension. Hypertension. 1998;32 (6):983–988.
  31. Grogan M, Smith HC, Gersh BJ, Wood DL. Left ventricular dysfunktion due to atrial fibrillation in patients initially believed to have idiopathic dilated cardiomyopathy. Am J Cardiol. 1992;69 (19):1570–1573.
  32. Петрухина А. А. Прогноз и лечение хронической сердечной недостаточности (данные 30‑и летнего наблюдения). Автореф. дисс.канд.мед.наук. Москва, 2008.
  33. Рогоза А. Н., Ощепкова Е. В., Цагареишвили Е. В., Гориева Ш. Б. Современные неинвазивные методы измерения артериального давления для диагностики артериальной гипертонии и оценки эффективности антигипертензивной терапии. Пособие для врачей. – М.: – МЕДИКА, 2007. – 72с.
  34. Nolan J, Batin P, Andrews R et al. Prospective study of heart rate variability and mortality in chronic heart failure; results of the United Kingdom Heart Failure Evaluation and Assessment of Risk Trial (UK-HEART). Circulation. 1998;98 (15):1510–1516.
  35. Ponikowski P, Anker SD, Chua TP et al. Depressed heart rate variability as an independent predictor of death in chronic congestive heart failure secondary to ischemic or idiopatic dilated cardiomyopathy. Am J Cardiol. 1997;79 (12):1645–1650.
  36. Szabó BM, van Veldhuisen DJ, van der Veer N et al. Prognostic value of heart rate variability in chronic congestive heart failure secondary to idiopathic or ischemic dilated cardiomyopathy. Am J Cardiol. 1997;79 (7):978–980.
  37. Garg R, Yusuf S, for the Collaborative Group on ACE Inhibitor Trials. Overview of randomized trials of angiotensin-converting enzyme inhibitors on mortality and morbidity in patients with heart failure. JAMA. 1995;271 (18):1450–1456.
  38. Fu M, Zhou J, Sun A et al. Efficacy of ACE inhibitors in chronic heart failure with preserved ejection fraction--a meta analysis of 7 prospective clinical studies. Int J Cardiol. 2012;155 (1):33–38.
  39. Меерсон Ф.3. Гиперфункция, гипертрофия и недостаточность сердца. – М.: 1968. – 388 с.
Kapanadze L. G., Gerasimova V. V., Mareev Yu. V. et al. Factors influencing 5‑year survival in patients with mild and moderate CHF: Role of office BP and parameters of 24‑h BP profile in disease prognosis. Russian Heart Failure Journal. 2013;14 (6):353-361

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