Russian Heart Failure Journal 2014year Pilot study of the prognostic significance for intervisit variability of clinical blood pressure in patients with low ejection fraction chronic heart failure

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Pilot study of the prognostic significance for intervisit variability of clinical blood pressure in patients with low ejection fraction chronic heart failure

Troitskaya E. A., Kotovskaya Yu. V., Babaeva L. A., Kobalava Zh. D.
Federal State Budgetary Educational Institution of Higher Professional Education “Russian University of Peoples’ Friendship”, Miklukho-Maklaya 6, Moscow 117198

Keywords: NT-proBNP, arterial hypertension, intervisit BP variability, prognosis, CHF

DOI: 10.18087/rhfj.2014.6.1979

Background. Evidence for importance of intervisit BP variability has been continuously growing; however, the main attention has been paid to patients with arterial hypertension (AH). Aim. To study predictors and prognostic significance of intervisit clinical BP variability in patients with stable CHF and impaired systolic function. Materials and methods. Retrospective analysis was performed for 40 patients with FC II–III stable CHF, EF <40 % and NT-proBNP >400 pmol / l, and available BP values for at least 7 visits for 18 months. Intervisit BP variability was calculated as SD of mean BP values for 7 successive visits on constant therapy. Endpoints included all-cause death; admission for CHF; MI; and stroke. Results. Data analysis was performed for 40 patients (33 males; mean age, 67.5±9.2; mean BP, 129.4±13.6 / 79.2±9.2 mm Hg; heart rate, 73.1±12.1 bpm; mean EF, 32.8±2.6 %; NT-proBNP, 2683.7±3635.4 pmol / l). Intervisit systolic BP (SBP) variability ranged from 2.3 to 16 mm Hg and diastolic BP (DBP) variability – from 1.8 to 10.3 mm Hg. Ten patients had 10 endpoints (2 deaths, 6 admissions, 1 MI, and 1 stroke). Differences in main clinico-demographic, hemodynamic, and laboratory parameters between groups with and without endpoints were absent. The groups significantly differed in intevisit SBP variability (11.9±3.64 mm Hg vs. 7.8±3.2 mm Hg, p <0.05). Mono- and multifactorial regression analyses confirmed the unfavorable prognostic significance of the intervisit SBP variability >8.7 mm Hg (RR, 1.46; 95 % CI, 1.1–1.93; p=0.01; sensitivity, 90 %; specificity, 67 %, AUC, 0.79). Conclusion. Individual intervisit BP variability was heterogenic in patients with compensated CHF and reduced EF despite stable therapy. Study results suggested a prognostic significance of increased intervisit SBP variability in this patient cohort.
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Troitskaya E. A., Kotovskaya Yu. V., Babaeva L. A. et al. Pilot study of the prognostic significance for intervisit variability of clinical blood pressure in patients with low ejection fraction chronic heart failure. Russian Heart Failure Journal. 2014;15 (6):361–368

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