AMBULATORY BLOOD PRESSURE MONITORING IN HEART FAILURE WITH PRESERVED EJECTION FRACTION PATIENTS

Abstract

Objective: 120 hypertensive patients (pts) aged 67,8 ± 1,2 years. 30 pts with essential hypertension (EH), 90 pts with EH complicated by heart failure with preserved ejection fraction (HFpEF), NYHA class II. Design and method: Doppler echocardiography, office BP measuring and ambulatory BP monitoring, 6 -minute walk test. Results: The increased values of office systolic BP (SBP) were determined in both groups (154,3 ± 1,4 mm Hg in HFpEF pts and 145,5 ± 2,3 mm Hg in EH pts, p < 0,01). But mean 24-h (141,0 ± 1,5 mm Hg vs 131,6 ± 1,9 mm Hg, p < 0,001), daytime (144,6 ± 1,5 mm Hg vs 136,7 ± 2,0 mm Hg, p < 0,01) and nighttime (134,0 ± 1,8 mm Hg vs 121,5 ± 3,2 mm Hg, p < 0,05) BP values were significantly higher in HFpEF patients. There is no limiting impact of high blood pressure (in the range up to 154,3 ± 1,4 mm Hg) on physical activity in patients with initial stages of HFpEF. Office DBP values were comparable in two groups and did not exceed the recommended range. Mean 24-h DBP values slightly exceeded the upper limits in both groups. 24-h pulse BP in HFpEF pts was 63,2 ± 0,9 mm Hg compared to 54,9 ± 1,4 mm Hg in EH pts, (p < 0,05). 54 HFpEF pts (60,0%) demonstrated abnormal pattern of day/night SBP dynamics and 37 pts (41,1%) - abnormal pattern of DBP, in case of EH - 43,3 % and 20,0 %, respectively. The normal BP circadian rhythm was recorded in 12 (40,0 %) EH pts compared to 16 (17,8 %) HFpEF pts (x2 = 6,21; p < 0,05). Conclusions: HFpEF patients demonstrated insufficient control of office and 24-h BP. 82,2% of HFpEF patients were characterized by pathological types of BP circadian rhythm with dominating non-dipper type confirming the increased risk of cardiovascular events in HFpEF patients. Inadequate control of blood pressure is an important factor in the development of chronic heart failure with preserved ejection fraction. Mean ambulatory systolic BP level, unlike the office systolic BP, is independently associated with the development of HFpEF.