LEFT VENTRICULAR EJECTION FRACTION DEPRESSION CORRELATES WITH 24 HOURS BLOOD PRESSURE PATTERN IN PATIENTS WITH CHRONIC HEART FAILURE

Abstract

Objective: To analyze possible differences in 24 h BP pattern in patients with Chronic Heart Failure (CHF) and Moderate (VEF 45–30%) or Severe (VEF < 30%) Left Ventricular Dysfunction (LVD). Design and method: In 154 patients with CHF, an echocardiogram and a 24-hour Ambulatory Blood Pressure Measurement were performed. We comparatively study patients with moderate and severe LVD Results: Baseline characteristics of patients according to ventricular dysfunction: moderate: (82p 23.4% women, mean age 67.9, BMI 29.7 Kg/hm2) versus Severe (72 p, 16.6% women, age mean 62 and BMI 30.6). Prevalence (%) of hypertension (66 vs 56 (*)), diabetes (38.8 vs 34.1 (**)), and dyslipidemia (55.5 vs 31.7 (*). Regarding the etiology: hypertensive (36.1 vs 31.7 (**)), ischemic (30.5 vs 21.9 (*)), and enolic (11.1 vs 7.3)(**)) were significantly higher (* = p < .001)(** = p < .05)among patients with severe ventricular dysfunction. Despite the fact that patients with severe ventricular dysfunction received a higher percentage of drugs (p < 0.001):RAS blockers,beta-blockers,loop diuretics,and antialdosteronics. The comparative results between patients with moderate and severe ventricular dysfunction: 24 h BP (mmHg).Systolic (S): (114.4 (*)110.8) and Diastolic (D): (64.7 (ns) 64.8); Daytime: PAS (116 (**)108), and PAD (66 (ns)66);Nocturnal SBP (111 (*)108,and DBP (61 (NS) 61.5 mmHg) 24 h Pulse pressure (mmHg) (50 (*)46) Variability BP systolic (mmHg): (15.3 (*)12.9) Non-Dipper Patterns (%): 58.1 vs 50 (*); Riser: 19.4 vs. 27 (ns). (*) = P < 0.05;(**) = p < 0.001 In the logistic regression analysis, increased risk for severe left ventricular dysfunction were found for: Mean BP < 80 mmHg (OR 2,82; CI 95% 1,104- 7,392) and male gender (OR:3,62, CI 1,130 – 9,447. After correction for confounding variables, such as number antihypertensive agents) Conclusions: Patients with severe LVD showed lower 24 hours BP levels. Despite the use of greater number of antihypertensive agents, lower BP levels in these patients seem to be related mainly to functional left ventricular depression. In patients with CHF male gender and lower BP levels could be considered as a marker for severe left ventricular dysfunction.