Abstract 1072: Home Blood Pressure Monitoring Provides Important Prognostic Information in Patients Treated With a Cardiac Resynchronization Therapy Defibrillator
Background: Hypertension is a common morbidity prior to the onset of heart failure (HF). Patients with systolic HF often have low BP, and lower SBP is a poor prognostic indicator. We evaluated a large cohort of CRT-D patients who remotely monitor Home BP to determine the prognostic information within the BP measurements.
Methods and Results: The ALTITUDE study was designed to address prospectively defined questions, as determined by an independent advisory panel, utilizing de-identified data from the Boston Scientific LATITUDE® remote monitoring system. Mortality data is obtained from the Social Security death index. We analyzed data from 4,558 CRT-D patients with >20 BP measurements within 60 days of initial BP (16.2 mo. avg. FU). Baseline BP standard deviation (SD) and mean value were analyzed as predictors of mortality using Cox regression adjusting for age and gender. Patient quartiles of pulse pressure (PP) were also predictors in Cox and Kaplan Meier models. Baseline implant characteristics were age (69±12 yrs), gender (74.1% male) mean SBP (121±17 mmHg), mean DBP (73±10 mmHg) and mean PP (48±15 mmHg). Decreased mean BP was associated with mortality (per 5 mmHg change): SBP (HR 1.11, p<.001), DBP (HR 1.14, p<.001), PP (HR 1.10, p<.001). Higher DBP SD was marginally associated with mortality (HR 1.22, p=0.04). Patients with PP between 12–37 mmHg had the lowest survival (HR 2.10, p<0.001) (Figure 1⇓).
Conclusion: Low DBP, SBP and PP are associated with mortality in patients with HF. Baseline PP below 37 mmHg is associated with a doubling of the hazard of death. Home BP monitoring via LATITUDE provides important prognostic information in a population of patients treated with CRT-D.