CENTRAL SYSTOLIC BLOOD PRESSURE AND ARTERIAL STIFFNESS IN PATIENTS WITH HEART FAILURE WITH DIFFERENT EJECTION FRACTION PHENOTYPES

Abstract

Objective: The aim of this study was to assess changes of central BP (cSBP,cDBP) and parameters of AS in HF with different ejection fraction (EF) phenotypes. Design and method: In 54 patients (61% males, 69.6±10 years, HTN 100%, median (med) EF 51% (IQR 38;55%), NTproBNP 623 (500; 1842) pg/ml; HFrEF 37%, HFmrEF 13%, HFpEF 50%), apart from routine tests, we assessed CBP and AS with applanation tonometry (SphygmoCor). cSBP above individual reference values [Herbert A,2014], central pulse pressure (cPP)>/=50 mmHg, carotid-femoral pulse wave velocity (cfPWV)>10 m/s, cfPWV above individual reference values [Eur Heart J,2010], and AS gradient (cfPWV/crPWV)>/=1 were considered abnormal. The statistical analysis was performed in the groups with EF >/=and<50%. p<0.05 was considered significant. Results: Median office BP was 117(106;130)/70 (68;80) mmHg, bPP 47 (37;56) mmHg; cBP 109.5(96;120.5)/71.5 (68;80) mmHg, cPP 35 (25;43) (p<0.05 compared to brachial measurements). Uncontrolled BP was observed in 26%, hypotension – in 3%. There were no differences in median BP and AS parameters across EF phenotypes. Elevated cSBP was observed in 33% (28.5% in EF >/=50%,38.4% in <50% (p >0.05)): 27.7% with office normotension, in 5.6% with office hypotension and in 66.7% with office HTN. cfPWV>10 ms was observed in 48.1%, cfPWV>individual reference values – in 33.3%, cPP >/=50 mmHg – in 18.5%, AS gradient>/=1–in 70.3% (in 48.1% of patients with normal cfPWV). Elevation of any AS parameter was present in 77.8%: 1–in 20.4%, 2–in 44.4%, 3–in 9.3%. Patients with cSBP elevation had higher uric acid (469.4±104.8vs367.1±126.5 μmol/l, Spearmen correlation coefficient r=0.34,p=0.04) (whole group); more often had CKD (50vs12.5%) (EF<50%); longer duration of HF (med 4.5 vs 1 year), higher BMI (med 39.4 vs 29.4 kg/m2) (EF>/=50%). Patients with cfPWV>10 m/s had higher total cholesterol (med 4.6vs3.7 mmol/l (whole group) and 4.5vs3.6 mmol/l (EF>/=50%)), patients with AS gradient>/=1 had higher triglycerides (1.3.vs0.8 mmol/l) (EF<50%),p<0.05 for trend. Conclusions: Patients with HF had high frequency of cSBP and AS elevation regardless of EF and BP control. The most common marker of AS increase was abnormal AS gradient. Elevation of cSBP may be associated with hyperuricemia.